State of New South Wales (Far West Local Health District) v Rinaudo
[2025] NSWPICMP 176
•18 March 2025
| DETERMINATION OF APPEAL PANEL | |
| CITATION: | State of New South Wales (Far West Local Health District) v Rinaudo [2025] NSWPICMP 176 |
| APPELLANT: | State of New South Wales (Far West Local Health District) |
| RESPONDENT: | Tanya Rinaudo |
| APPEAL PANEL | |
| MEMBER: | Jane Peacock |
| MEDICAL ASSESSOR: | Professor Nicholas Glozier |
| MEDICAL ASSESSOR: | John Lam Po-Tang |
| DATE OF DECISION: | 18 March 2025 |
CATCHWORDS: | WORKERS COMPENSATION - Workplace Injury Management and Workers Compensation Act 1998; psychological injury; appellant employer alleged assessment on the basis of incorrect criteria and demonstrable error in the making of assessments under two of the psychiatric impairment rating scale (PIRS) categories (social and recreational activities, and social functioning) and limiting the deduction to one-tenth under section 323; Held – error found in the assessment of social and recreational activities as a Class 3 when it should have been assessed as a Class 2; no error in the social functioning assessment and the deduction of one-tenth; Medical Assessment Certificate revoked. |
BACKGROUND TO THE APPLICATION TO APPEAL
On 14 January 2025, the employer the State of New South Wales (Far West Local Health District) (the appellant), lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by Dr Clayton Smith, a Medical Assessor, who issued a Medical Assessment Certificate (MAC) on 17 December 2024.
The appellant relies on the following ground 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 grounds of appeal on which the appeal is made.
Rule 128 of the Personal Injury Commission Rules 2021 (the PIC Rules) and Procedural Direction PIC7 - Appeals, reviews, reconsiderations and correction of obvious errors in medical disputes set out the practice and procedure in relation to the medical appeal process under s 328 of the 1998 Act. An Appeal Panel determines its own procedures in accordance with r 128(1) of the PIC Rules.
The assessment of permanent impairment is conducted in accordance with the SIRA NSW Workers Compensation Guidelines for the Evaluation of Permanent Impairment, 4th ed
1 March 2021 (the Guidelines) and the American Medical Association Guides to the Evaluation of Permanent Impairment, 5th ed (AMA 5).
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.
The appellant did not request that she undergo a re-examination. As a result of its preliminary review, the Appeal Panel determined that it was not necessary for the worker to undergo a further medical examination because although the Appeal Panel found error, there was sufficient material before the Appeal Panel to enable a determination to be made.
EVIDENCE
Documentary evidence
The Appeal Panel has before it all the documents that were sent to the Medical Assessor for the original medical assessment and has taken them into account in making this determination.
Medical Assessment Certificate
The parts of the medical certificate given by the Medical Assessor that are relevant to the appeal are set out, where relevant, in the body of this decision.
SUBMISSIONS
Both parties made written submissions. They are not repeated in full, but have been considered by the Appeal Panel.
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 matter was referred to the Medical Assessor for assessment as follows:
“The following matters have been referred for assessment (s 319 of the 1998 Act):
· the degree of permanent impairment of the worker as a result of an injury (s319(c));
· whether any proportion of permanent impairment is due to any previous injury or pre-existing condition or abnormality, and the extent of that proportion (s319(d));
· whether impairment is permanent (s319(f)); and
· whether the degree of permanent impairment of the injured worker is fully ascertainable (s319(g)).
· Date of injury: 07/11/2019
· Body parts/systems referred: Psychological/Psychiatric disorder
· Method of assessment: Whole Person Impairment”
The Medical Assessor issued a MAC certifying as follows:
| Body Part or system | Date of Injury | Chapter, page and paragraph number in NSW workers compensation guidelines | Chapter, page, paragraph, figure and table numbers in AMA5 Guides | % WPI | WPI deductions pursuant to S323 for pre-existing injury, condition or abnormality (expressed as a fraction) | Sub-total/s % WPI (after any deductions in column 6) |
| 1. Psycho-logical | 7/11/19 | 11, page 55-60 | 14 | 17 | 1/10 | 15 |
| Total % WPI (the Combined Table values of all sub-totals) | 15% | |||||
The assessment was based on his assessment under the psychiatric impairment rating scale (PIRS) as required by the Guidelines as follows: (emphasis in original)
“Table 11.8: PIRS Rating Form
| Name | Tanya Rinaudo | Claim reference number (if known) | W8327/22 |
| DOB | Xxxx | Age at time of injury | 46 |
| Date of Injury | 07/11/2019 | Occupation at time of injury | Nurse Unit Manager |
| Date of Assessment | 10/12/2024 | Marital Status before injury | Married |
| Psychiatric diagnoses | Persistent depressive disorder |
| Psychiatric treatment | Psychiatric treatment, antidepressants, long term psychotherapy |
| Is impairment permanent? | Yes |
| PIRS Category | Class | Reason for Decision | |||||||||
| Self-care and personal hygiene | 2 Mild Impairment | Ms Rinaudo is able to live independently and look after herself adequately. She sometimes skips showering. She can independently maintain a minimum level of hygiene and nutrition. | |||||||||
| Social and recreational activities | 3 Mild Impairment | Ms Rinaudo’s opportunities for social and recreational activities are in part limited by her location and lack of local friends. However, she continues socialising with her husband, stepdaughter, and grandchildren with weekly restaurant outings and outings for coffee with her husband. She regularly participates in craft. Outside of her immediate family she has few social outlets. She has stopped bible study. I note that her physical problems have significantly limited her capacity to socialise and engage in recreational activities, and more recently, there were difficulties related to her husband, which made it difficult for her to socialise locally. | |||||||||
| Travel | 1 No Deficit | Ms Rinaudo travels without a support person and has visited friends in the Gold Coast, Hervey Bay, and Melbourne. The predominant restriction on her ability to travel is her physical health problems. | |||||||||
| Social functioning | 2 Mild Impairment | Ms Rinaudo has lost some friendships. Her relationship with her husband is strained but intact. Her strained relationship with her children predated the injury. She continues to be actively involved with her stepdaughter’s children. | |||||||||
| Concentration, persistence and pace | 3 Moderate Impairment | Ms Rinaudo cannot focus on reading or absorbing information. She has handed over the intellectually demanding household responsibilities and administration to her husband and avoids intellectually demanding activities. Her craft activities are self-paced and low-pressure. | |||||||||
| Employability | 5 Totally Impaired | Ms Rinaudo lacks the cognitive, emotional and interpersonal flexibility to cope with paid employment and is on a Disability Support Pension. | |||||||||
| Score | Median Class | ||||||||||
| 1 | 2 | 2 | 3 | 3 | 5 | =3 | |||||
| Aggregate Score Impairment | Total | % | |||||||||
| 1+2 | +2 | +3 | +3 | +5 | 16 | 17% | |||||
The Medical Assessor made a deduction of one-tenth under s 323 in respect of a pre-existing condition, abnormality or injury, leaving the total whole person impairment (WPI) assessed as a result of injury as 15%.
The employer appealed.
In summary, the appellant submitted that the Medical Assessor made assessments on the basis of incorrect criteria and/or made demonstrable errors in the assessments she made under five of the PIRS categories, as follows:
(a) in assessing Class 3 for social and recreational activities when he should have assessed no deficit at Class 1;
(b) in assessing Class 2 for social function when he should have assessed no deficit at a Class 1, and
(c) in making a deduction of on-tenth under s 323 when he should have assessed a higher deduction.
In summary, the respondent worker Ms Tanya Rinaudo (the respondent) submitted that the Medical Assessor did not err or make an assessment on the basis of incorrect criteria and the MAC should be confirmed.
The role of the Medical Assessor is to conduct an independent assessment on the day of examination. The Medical Assessor is required to take a history, conduct a mental state examination, make a psychiatric diagnosis and have due regard to other evidence and other medical opinion that is before the Medical Assessor. The Medical Assessor must bring his clinical expertise to bear and exercise his clinical judgement when making an independent assessment of impairment under the PIRS categories. The assessment is not to be based upon self-report alone. An appeal panel cannot disturb ratings under the PIRS scale for mere difference of opinion but must be satisfied as to error.
The path of reasoning disclosed by the Medical Assessor must be adequate. This is also dependent on the extent of the history taken and a thorough examination of the worker so that self- report can be properly evaluated in the context of other evidence before the Medical Assessor.
The Medical Assessor took a history which he recorded as follows: (emphasis in original)
“Brief history of the incident/onset of symptoms and of subsequent related events, including treatment:
Ms Rinaudo is a 61-year-old woman in a 26-year marriage. She has two children from her first marriage and two stepchildren from her second marriage. Since my last examination, her husband has become her paid carer and has been approved for the Disability Support Pension. They live in their own home in Queenstown, Tasmania, a small country town two and a half hours from Burnie.
She was psychologically injured while employed as a Nurse Unit Manager at Wilcannia Hospital in August 2019. Before working at Wilcannia Hospital, she was a contract nurse in various remote locations. She was employed by Tjuntjuntjara before her appointment at Wilcannia. Her employment with Tjuntjunjara was terminated in January 2019. She told me that the manager misappropriated medical information and equipment, and Ms Rinaudo refused to back her. She said she was given a dismissal letter, and “I was driven out of town that same morning”. She lodged a WorkCover claim at the time for a psychological injury. Her WorkCover claim was initially declined.
She was on duloxetine 30 mg since she had a back injury as a paramedic in 2007 for nerve pain in her legs. Her general practitioner increased her duloxetine dose to 60mg, and she was given clearance to work. She was employed at Nukanba full-time as a remote area nurse. She said she recovered from her depressive symptoms related to her employment at Tjuntjunjara because she had good colleagues and managers and made friends with the teachers at the local school. She described it as a friendly community. She was approached about the job at Wilcannia. She said she had no experience as a nurse manager but was told that she would be trained and be able to use her paramedic background. She remained on duloxetine leading into her employment at Wilcannia.
She was looking forward to the job when she arrived at Wilcannia, and her husband was thinking about relocating there to work. She said that in the second week in September, the director of nursing/acting health service manager started humiliating and belittling her and applying unrealistic expectations. She said she stopped enjoying her out-of-work activities, particularly her crafts. She said they lived in a small compound with a few units, and she could not leave her unit because she felt like the director of nursing was always there watching. She said she felt depressed and anxious and dreaded going to work. She withdrew from people, although she made friends with two enrolled nurses. She said she knew she could not cope with the bullying and harassment and called a nursing agency to find alternative employment. She said she was talked out of resigning by the new health services manager.
On 5 November 2019, she claimed she was set up regarding handling S8 drugs contrary to New South Wales Health legal requirements. She was taken to task by the manager. She became depressed and felt betrayed, and on 7 November, she went home from her shift and took an overdose of diazepam to commit suicide. She was briefly admitted to Broken Hill Hospital until her husband collected her and took her back to Burnie.
After she left work, she briefly saw a psychologist in Burnie. A psychologist from Queensland then treated her via video link. She started seeing Claire Jensen, a Psychologist, in February 2020 and had 8 sessions. She had not seen a psychiatrist for treatment at my initial examination. Her general practitioner was managing her medications. She remained on duloxetine, and the dose was increased from 60mg to 120 mg soon after the overdose. She has since switched from duloxetine to escitalopram to fluoxetine. Since my last examination, she has been referred to a psychiatrist and has been seeing the psychiatrist monthly. She changed her antidepressant medication to fluoxetine about eight months ago. She has switched from a low-dose tricyclic antidepressant at night to mirtazapine 15 mg. She consults with Barry Gerhardt, a clinical psychologist, since February 2021, more recently at monthly intervals.
She has continued to feel depressed and anxious since leaving Wilcannia in 2019.
· Present treatment:
Ms Rinaudo is on fluoxetine 40 mg daily, mirtazapine 15 mg at night, spironolactone 25 mg daily, carbamazepine 400 mg twice a day for nerve pain, domperidone 10 mg in the morning for chronic nausea and vomiting (under investigation), cyclizine 50 mg in the morning for nausea, olmesartan 40/25 daily, pramipexole 1 mg at night and Targin as required. She said she might take Targin every few days depending on her activity levels, for example, if they go for a drive out of town or if she is seated for a long time. Since our last examination, she has stopped semaglutide and sulfasalazine.
· Present symptoms:
Ms Rinaudo’s mood is usually low or flat. She continues to ruminate about the events in Wilcannia and the sense of injustice. She continues to feel “tormented” by her former manager. She denied auditory hallucinations although earlier on in the course of her injury she reported hearing people calling her name.
She reported that mirtazapine is helping her sleep. She sleeps for four to five hours per night and does not nap during the day.
Her weight is stable. She has been trying to lose weight with little success. She said she typically picks at food and has a limited appetite.
Recently, her husband has been taking her out once a week in the evening to a quiet restaurant, a local motel on the edge of town.
She experiences recurrent suicidal thoughts every few weeks, feeling worthless and useless. Her husband controls her tablets due to reports of overdosing. She said that the fact her career was taken from her made her feel worthless and useless.
She said she is not enjoying much and is going through the motions. She reported difficulty with motivation, maintaining a clean house and engaging in activities she once enjoyed such as reading and listening to music. She is intolerant of noise.
She experiences significant pain in her hips, which limits her mobility. She is restricted in how long she can sit.
She reported feeling like a burden on her family and having persistent problems trusting people.
She denied intrusive thoughts about her work as a paramedic. She told me that her predominant preoccupation is thoughts of Wilcannia.
She denied symptoms consistent with obsessive compulsive disorder, mania, hypomania or psychosis.
· Details of any previous or subsequent accidents, injuries or condition:
On my last examination, Ms Rinaudo denied any history of childhood sexual abuse or adverse developmental history, contrary to the information in the mental health assessments from Broken Hill Hospital after the overdose in 2019. At this examination, she recalled that a farm worker sexually abused her in childhood. She told me she could not recall much of the abuse and denied any lasting effects. She recalled, while laughing and with incongruent affect, her mother “taking to him with a broomstick” after she told her mother.
She told me her mother was a hard mother who had grown up as a Jew in Germany in World War II. Her mother was strict; they did not go much, went to school, came home, and did their chores. Her mother was prone to frightening emotional meltdowns, and Ms Rinaudo recalled times when she had to ‘disappear out of the house with my sister’. She described her mother as irrational. Ms Rinaudo said she suspected her mother suffered from undiagnosed PTSD. She recalled her mother had essential tremors, causing her head to shake. She recalled corporal punishment and told me it was ‘not a loving household’. Her father was usually absent because he was working. She said her mother was deeply changed by the death of her sister as a child from gastroenteritis.
She saw a psychologist in 1996 when her first marriage ended for several months and tried marriage counselling. She was not on medication.
She had an episode of depression in 2005 with a work-related psychological injury while employed as a paramedic and took five months off work after being subjected to inappropriate sexual advances by a co-worker. She was treated with medication and by a psychologist. She said her condition improved when she was removed from the Comms Room and was recertified to allow her to resume active duty on the road as a paramedic. She sustained a back injury in 2007 and could no longer continue working as a paramedic, so she began training as a nurse. She has been nursing ever since. She said she was happy and enjoyed her studies. She started working as a registered nurse in January 2009. She worked continuously between 2009 and 2019. She felt confident in her knowledge and skills, so she went bush nursing. She was on 60 mg of duloxetine throughout for back pain. She was not seeing a psychiatrist or psychologist.
She denied any suicide attempts before 2019. I note from the documentation she developed suicidal thoughts after the incident at Tjuntjuntjara but no attempts. Her only psychiatric admission was brief in Broken Hill after the suicide attempt in November 2019.
There were legal difficulties with her husband in 2017. Her daughter’s partner and daughter were abusing drugs and wanted money from Ms Rinaudo to get themselves out of debt. An allegation of sexual abuse was made against her husband, who was convicted and incarcerated for six months. She was subsequently estranged from her two older children. The matter was concluded around 2017 or 2018, and he was released from prison at the end of 2017. I noted references in the documentation to her husband's recent two-week incarceration, which caused her difficulties with feeling judged by the local community.
· General health:
She has wine, muscat or port, a glass every few nights. She denied symptoms suggestive of an alcohol use disorder. She is a non-smoker and denied problem gambling, illicit drug use or any forensic history. She noted she has been online shopping for craft materials excessively.
She has had a chronic back injury since 2007 related to her employment as a paramedic. Ms Rinaudo underwent a spinal fusion at L4, L5, L5/S1 in July 2023. She reported an improvement in her pain since the surgery. She is awaiting a right-sided hip replacement for which she is on a waiting list. She can walk about two blocks with her husband assisting. She walks with a stick if unaccompanied.
She was diagnosed with fibromyalgia around 2020, a condition characterised by widespread pain, fatigue, sleep disturbances and other symptoms such as headaches, cognitive difficulties and mood disturbances. It is believed to be a disorder of central pain processing and is often associated with conditions such as chronic fatigue syndrome and depression.
She has had hypothyroidism for many years, secondary to Hashimoto’s thyroiditis.
· Work history including previous work history if relevant:
She finished school in year 12 and became a paramedic. She retrained as a registered nurse after she injured her back at work in 2007. She started working as a registered nurse in January of 2009. She worked continuously between 2009 and 2019. She felt confident in her knowledge and skills, so she went bush nursing.
Before working at Wilcannia Hospital, she was a contract nurse in various remote locations. She was employed by Tjuntjuntjara before her appointment at Wilcannia. Her employment with Tjuntjunjara was terminated in January 2019.
She was on duloxetine 30 mg since she had a back injury as a paramedic in 2007 for nerve pain in her legs. Her general practitioner increased her duloxetine dose to 60mg and she was given clearance to work. She was employed at Nukanba full-time as a remote area nurse. She said she recovered from her depressive symptoms related to her employment at Tjuntjunjara because she had good colleagues and managers and made friends with the teachers at the local school. She described it as a friendly community. She was approached about the job at Wilcannia. She said she had no experience as a nurse manager but was told that she would be trained and be able to use her paramedic background. She remained on duloxetine leading into her employment at Wilcannia.
She attempted to return to work and was recruited to the Kimberley KAMS (Kimberley Aboriginal Medical Service) on a six weeks on, three weeks off roster, fly in fly out arrangement. She was due to start on 19 December 2019. She never started the position because she overdosed and her husband took her back to Tasmania in November 2019. She was offered a job on night shift in a nursing home in 2020 and worked full-time for three months, but could not cope. She said she worked as a Rail Operations Manager in Queenstown around 2 March 2020 for several months with the assistance of a friend.
· Social activities/ADL:
She showers every few days due to lack of motivation. She has her hair cut every two months and her sister takes her to the hairdresser. She spends most of her time at home engaging in craft activities, watching movies and doing minimal housework. She does not cook and relies on her husband for most household tasks.
She does not read for pleasure having previously enjoyed reading. She told me she could not absorb information and read the same paragraph repeatedly. She is capable of participating in online shopping, uses Pinterest, checks her emails occasionally, rarely uses Facebook due to limited motivation or interest and plays games such as dominos on her smartphone. Her husband takes care of the family finances.
Ms Rinaudo avoids social interactions, only seeing her sister and stepdaughter regularly. Her main social contact is her sister who has moved locally to be closer to Ms Rinaudo. She visits several times per week. They talk or watch a movie. Occasionally she takes her for a coffee about once a week and sometimes on the weekend. They have taken a trip to Burnie occasionally when her sister goes to pick up groceries. Her sister has no children and is single.
Her stepdaughter brings her three grandchildren to their house once a week to once a fortnight. They do crafts together. Her daughter lives in Brisbane with three children, and they have very little contact, a longstanding problem predating the subject injury. Both her children from her first marriage are substance-dependent and estranged. She noted that she had to report her daughter to family services.
Her stepson is a paramedic and lives in Tasmania and visits occasionally when not busy working.
She has a local friend, a remote area nurse and a former colleague. Although she is often on contract and away, they remain in touch and catch up when she is local. She mentioned that she had a falling out with her friend Maureen due to Maureen’s husband's inappropriate behaviour. They no longer have any contact.
She said her relationship with her husband is strained due to her “trust issues”. They are not planning to separate.
She mentioned that she could stand for a bit longer since her surgery while doing her craft. She can sit and watch an entire movie. She can drive short distances to town to check the mail. Her husband will take her for coffee every few days when she feels like going out. They will take a drive to Burnie when her husband wants to go to Bunnings. She attends occasional medical appointments such as the orthopaedic surgeon, gastroenterologist and endocrinologist.
She stopped Bible study more than 12 months ago. She lost motivation. She is not going to church.
She flew to the Gold Coast alone for 10 days to visit and support a girlfriend with a terminal illness. She told me her husband put her on the plane, and her friend met her at the other end. She took the ferry to Melbourne independently to visit a girlfriend and spent a weekend last month alone. They spent four days together in the Dandenongs in a cabin and enjoyed each other’s company. On 14 March 2024, in handwritten notes by her psychologist, I noted she was in Hervey Bay, noting that she had a ‘catch-up with her older sister today and will catch up again on Sunday.’ On 5 April 2024, she was noted to be going to the Twilight Markets in Hobart.
She reported feeling terrified at the thought of returning to work and has no plans to do so. She is now on the Disability Support Pension.’
The Appeal Panel is satisfied that an adequately detailed history was taken, which is broadly consistent with the other evidence before the Medical Assessor. Medical Assessors have to obtain a focussed history and undertake a mental state assessment within a finite appointment time. The medical assessor recorded his findings on mental state examination as follows:
“Ms Rinaudo presented on time. She had a short, grey bob. She was in casual attire, overweight and had taken no particular care with her appearance. Her affect was restricted and dysphoric. Her speech was of normal rate, tone and volume. She described her mood as depressed.Her thought content included depressive themes such as feeling like a failure, a burden on others and worthless. She described rumination about the events at Wilcannia but denied intrusions related to her employment as a paramedic. She reported recurrent suicidal thoughts with no immediate plan. She described feeling diminished and damaged by her experiences in Wilcannia. There was no evidence of psychotic symptoms and she denied auditory hallucinations.
She was alert and oriented and her intelligence was estimated to be in the average range. Her cognition was not formally tested. There were no overt cognitive deficits during the interview. She was able to pay attention and her narrative was cohesive and logical. Her insight and judgment were intact. She claimed to adhere to treatment as prescribed.”
The Medical Assessor summarised the injury and her diagnosis as follows:
“Summary of injuries and diagnoses:
Ms Rinaudo’s condition meets DSM-5 criteria for a persistent depressive disorder. She reported depressed mood and a loss of pleasure in previously enjoyed activities for most of the day for more days than not for at least two years. She described insomnia, fatigue, apathy, impaired confidence, poor concentration and depressive thoughts including rumination and recurring suicidal thoughts. Her symptoms have fluctuated but she has never been without the symptoms described above for more than two months at a time.
She has non-work related injuries and subsequent stressors that contribute to the current level of impairment particularly chronic back pain (requiring surgery) and fibromyalgia (commonly associated with pain, impaired cognition and depression).
Consistency of presentation:
Ms Rinaudo presented as a consistent historian. Her presentation was consistent with the mechanism of injury. The mental state examination was consistent with persistent depressive disorder.”
The Medical Assessor made an assessment of WPI in accordance with his assessment under the six PIRS categories as set out above.
The Medical Assessor made brief comment on the other opinions as follows: (emphasis in original)
“My brief comments regarding the other medical opinions and findings submitted by the parties and, where applicable, the reasons why my opinion differs:
In her statement dated 11 November 2022, Ms Rinaudo noted she started seeing Claire Jensen, Psychologist, in February 2020 for 8 sessions. Since February 2021, she has seen Barry Gerhardt, Clinical Psychologist, fortnightly. She was prescribed duloxetine 120 mg and nortriptyline 25 mg by her general practitioner. She was waiting to see a psychiatrist. She tried to return to work from 15 November 2020 to 30 December 2020 at an aged care facility at a night shift supervisor. She ceased this employment because she found the work too stressful and was terrified she would be bullied and harassed. She was unable to engage in any form of employment since 30 December 2020. She detailed the disabilities, referring to the Psychiatric Impairment Rating Scale categories.
In a supplementary statement dated 30 November 2020, Ms Rinaudo noted being employed between 9 September 2020 and 30 October 2020 as a Reaccreditation Trainer for aged care workers employed by Medex Learning. She ceased employment with Medex Learning on 30 October 2020 as she could not tolerate the stress associated with the position. She was working a maximum of two working days per week and on some weeks, no shifts at all.
Statement by Tanya Rinaudo, dated 10 September 2020, noted she had obtained a Bachelor of Nursing from the University of South Australia and was a qualified paramedic. She was employed as a remote nurse working with Kimberley Population Health Unit for four months as a clinical nurse specialist. On 26 August 2019, she was employed by the Department of Health New South Wales as a Nurse Unit Manager. She was working at Wilcannia Hospital working 38 hours per week. She noted her prior injuries. In 2006, she was sexually harassed and stalked by her manager while working for Rural Ambulance Victoria. She could not recall making a Workers’ Compensation Claim. She sustained an injury to her back in 2007 while retrieving and unconscious patient. About January 2018, she became depressed when she was unfairly dismissed from her employment with Tjuntjuntjara Medical Clinic.
She was not prescribed medication for the injury and did not make a Workers’ Compensation claim. She was prescribed Valium for back spasms. She has permanent nerve damage around her lower back and saddle region.
She detailed the circumstances of the psychological injury, noting that she was harassed by Samantha Elliot, the acting Health Service Manager. She detailed the incidences of bullying and harassment. She attempted to resign in late September 2019 and was convinced otherwise by the new full-time Health Services Manager,
Mr Oxford. She withdrew her resignation. On 5 November 2019, two of her reports,
Ms Cooper and Ms O’Sullivan, failed to properly record or retain Schedule 8 drugs received from a doctor, not complying with legal procedure. She was accused of improper practice with respect to the S8 drugs. She described an angry confrontation with her manager, where she felt unfairly blamed and set up for the incident. She was so distressed she returned home and took an overdose of diazepam. She noted symptoms of depression and anxiety. She had a brief admission Broken Hill Mental Health Unit as a voluntary patient. She was discharged into her husband’s care and returned to Tasmania. She was taking duloxetine 90 mg and mirtazapine 30 mg. In December 2019, she attempted to return to work with Westcoast Wilderness Railway as an assistant to the operations manager. She did not cope because of issues with her memory. She ceased her employment with Westcoast Wilderness in March 2020.Section 78 Notice dated 8 November 2022 noted a claim for 15% whole person impairment based on the report by Dr Ben Teo dated 5 May 2022, noting a diagnosis of chronic adjustment disorder with anxious mood. No deduction was made for a pre-existing condition.
Ms Rinaudo was assessed by Dr Bisht, Psychiatrist, who provided a report dated 27 October 2022. Other relevant stressors were noted including a diagnosis of fibromyalgia, ongoing problems with her back, high blood pressure, cholesterol, reflux, irritable bowel syndrome and Hashimoto’s disease. They noted a past history including the incident in 2006 with her manager with symptoms of adjustment disorder and a few sessions with a psychologist at the time and a change to a different state. They noted the chronic back injury since 2007 with ongoing nerve pain. They noted a prescription of duloxetine since 2011 for nerve pain. They noted a history of depression on 28 May 2015 as a result of “a nasty call” from general practitioner which “set off PTSD issues”. At the time, it was recommended that she increase the dose of her antidepressant. They noted the medical records with difficulties in January 2016 as her husband was facing trial for underage sex with his stepdaughter. They noted the onset of symptoms in December 2018 due to work-related pressures, stating she had been laid off from work whilst on WorkCover. On 7 February 2019, she reported having suicidal ideation without intent or plan. On 8 February 2019, she was given a script for an increased dose of antidepressant medication and referred for psychological counselling.
On 28 February 2019, she was provided with an approval to return to work on full capacity subject to compliance with her psychiatric medication and ongoing psychological support. She was on contract from September 2018 in Tjuntjunjara and her employment was terminated in January 2019. She tried to make a WorkCover claim but the liability was denied. She had a few sessions with a psychologist at the time, but could not remember whether her antidepressant dose was increased or not. Dr Bisht made a diagnosis of persistent depressive disorder due to the duration of symptoms and their deterioration. He noted it was an aggravation of the pre-existing psychological condition. He assessed whole person impairment at 15%, deducting 10% of the 15% impairment due to pre-existing impairment and a further 1.5% for the comorbid conditions. Dr Bisht noted the difficulties demarking the impact of the work-related condition to the impact of other stressors, which he considered substantial. He concluded she would have developed an adjustment disorder in the context of non-work-related stressors, even if she had not suffered from the work-related injury. His final assessment of the whole person impairment was 12%. Liability for whole person impairment was denied.
Section 78 notice dated 22 June 2020 disputed liability for the claim, disputing a psychological injury, disputing her employment with Far West New South Wales Local Health District was a substantial contributing factor to any injury, nor was it the main contributing factor and had the injury occurred it was wholly or predominantly caused by reasonable action taken or proposed to be taken by her employer with respect to performance, appraisal and/or discipline.
Samantha Elliott, Acting Health Services Manager, refuted Ms Rinaudo’s claims.
Ms Elliott noted performance issues requiring her to upskill.I reviewed notes from Broken Hill Hospital, recording a history of psychological issues dating back to childhood, including a history of childhood sexual assault and a difficult relationship with her mother. I noted that Ms Rinaudo had endorsed a general health screening document incorrectly given her history of depression.
Initial report by Dr Bisht noted that the workplace was only partly contributing to her condition, but the main contributing factor was decompensation of a prolonged psychiatric condition.
A Review Notice dated 8 September 2020 from QBE insurance noted the original decision to deny her claim was maintained, noting a shift in the narrative in her reports to the independent medical examiner, Dr Oldtree Clark, on 5 August 2020, failure to disclose a pre-existing condition and noting evidence of increased dosage of antidepressant medication and psychological counselling in February 2019, prior to obtaining employment with the insured with medical clearance on 28 February 2019 on the basis that she complied with taking psychiatric medication and attending for ongoing psychological support. It concluded her ongoing symptoms and current incapacity related solely to the natural progression of her pre-existing and longstanding psychological issues supported by Dr Bisht. I noted her employment as a Rail Operations Administration Officer around 2 March 2020.
In his report dated 5 May 2022, Dr Ben Teo, independent medical examiner, detailed the circumstances of the injury. He briefly discussed Ms Rinaudo’s past psychiatric history. He diagnosed chronic adjustment disorder with anxious mood. He concluded she had reached maximum medical improvement, assessing whole person impairment at 15% with Self-care and Personal Hygiene Class 1, Social and Recreational Activities Class 3, Travel Class 2, Social Functioning Class 3, Concentration, Persistence and Pace Class 3, Employability Class 3.
In his report dated 5 August 2020, Dr Thomas Oldtree Clark detailed the circumstances of the injury. He did not note the history of fibromyalgia under the medical history. He did not discuss her past psychiatric history, in particular, her previous WorkCover claim for a psychological injury. He diagnosed a major depressive disorder on DSM-5 criteria. He concluded she had not reached maximum medical improvement.
Report by Dr Thomas Oldtree Clark dated 27 September 2020, in his response to question 1, whether Ms Rinaudo had sustained an aggravation, acceleration, exacerbation or deterioration of any disease, Dr Oldtree Clark noted that there was no evidence present in the records that she was unfit for her job when she was appointed as a Nurse Unit Manager and she had been employed according to the normal New South Wales Health Procedures, including registration records, criminal history and physical medical certification. He noted that the procedures would examine any prior issues by previous employers. He did not address Ms Rinaudo’s past psychiatric history and evidence of psychological disturbance soon before she started employment as the nurse unit manager at Wilcannia as detailed by the insurer in the Section 78 notice. Dr Oldtree Clark had access to the report by Dr Bisht dated 3 June 2020.
Psychological Treatment Report by Dr Claire Jensen, Clinical Psychologist, undated, noted a diagnosis of anxiety and depressed mood. Ms Rinaudo was noted to report improved symptoms, ability regulate her mood and recommended a gradual supported return to work. She recommended continued psychological support to prevent relapse.
A letter by Dr Matt Despot, General Practitioner, dated 6 August 2021 supported Ms Rinaudo’s total and permanent disablement claim.
In a report by Barry Gerhardt, Clinical Psychologist dated 22 February 2021 it noted a referral for psychological assessment and treatment noting elevated scores on a range of measures indicating anxiety and depression. It noted a score 68% on the Oswestry scale, indicating she was classified in the ‘crippled’ range, where back pain impinges on all aspects of life, home and at work. It noted she presented with persistent pain from fibromyalgia, auditory hallucinations, stress, perfectionism, procrastination, sleep, past bullying, civil litigation, boundary, adjustment and low self-esteem issues in addition to symptoms of anxiety and depression. This was their initial session.
Patient Health Summary printed on 26 August 2020, various dates, noted a history of depression on 7 February 2019 and 5 December 2019. Duloxetine 60 mg was noted in her medication list. Entry on 5 December 2019 noted anxiety, depression and chronic pain, starting work on 19 December in Kimberley and wants to have a clearance. No records were available predating the injury.
Psychologist notes by Claire Jensen, various dates, noted continued symptoms of depression and anxiety. She attended eight sessions.
In his report dated 27 October 2022, Dr Yajuvendra Bisht, detailed the circumstances of the injury in his previous report. He detailed continued symptoms of anxiety and depression. He noted a range of subsequent stressors, as detailed in the Section 78 Notice. He took an extensive history of her psychiatric history before the injury. These were also detailed in the Section 78 Notice. He noted a diagnosis of persistent depressive disorder per DSM-5 criteria. He noted that employment was a substantial contributing factor to an aggravation of a pre-existing psychiatric condition. He noted “stressful experiences did indeed occur, predominantly in the form of the performance management process. The aggravation of the condition coincided with the stressful experiences. These stressors would be considered severe enough to worsen her pre-existing psychological condition. He noted it was not her pre-existing issues which mainly or substantially contributed to her decompensation because she became a registered nurse and in 2009, she had maintained continuous employment until the work-related aggravation. He noted the psychological injury had not resolved because she continued to ruminate about the stressful experiences in the workplace and remained hypervigilant about similar experiences in the future. He apportioned employment with the insured as 80% responsible for her psychological condition, 10% relevant on work-related factors and 10% for a pre-existing psychological condition. He concluded maximum medical improvement had been reached and rated psychiatric impairment rating scale at 15% whole person impairment with a 1.5% deduction for a pre-existing impairment and a deduction for comorbid conditions of 1.5%. This led to a final whole person impairment of 12%. He noted Section 11.9 of the New South Wales’ Workers’ Compensation guidelines requiring consideration of comorbid features, noting the other stressors in her life after the onset of the work-related injury, her pre-existing psychiatric history, indicating that she was vulnerable to developing stress-related psychiatric conditions, noting that the subsequent stressors had been substantial, concluding that she would have developed an adjustment disorder regardless of the work-related injury in the context of substantial non-work-related stressors. He noted that his deduction of 10% was warranted because he could not precisely demarcate the impact on functioning of the work related versus non-work-related factors. There was no adjustment for the effects of treatment.
The hospital admission and discharge documentation dated 7 November 2019 noted referral of Ms Rinaudo following a suicide attempt. Mental health assessment at Wilcannia Hospital by Robyn Gel, Registered Nurse, dated 8 November 2019, noted that Tanya had been travelling doing remote area nursing for seven years, placing a strain on the relationship with her husband. Other stressors noted included Tony, her husband, recently being incarcerated for six months due to allegations made by Tanya’s daughter. She had no contact with her two adult children from her first marriage. It noted that Tanya has been treated for depression in the past due to bullying at other workplaces. It noted that she had had suicidal ideation on and off but no previous attempts. It noted that Tony was unable to work as a paramedic due to charges/convictions, so they have a lot of debt. It noted that Tanya’s mother has a history of mental illness, but Tony was unsure of the exact diagnosis. It noted that Tanya had stated she had suicidal thoughts in January 2019 due to a bullying incident where she was working. She denied any previous attempts. She reported she was on duloxetine due to her chronic pain from her back injury. Husband reported she has a diagnosis of depression. She denied any family history of mental illness or past trauma (husband reporting Tanya’s mum had mental health issues and she had a very difficult upbringing).
Assessment by Dr Alexander Freeman, Registrar, dated 12 November 2019 noted ‘January 2019 Argument with manager on placement in remote Western Australia. Thoughts of overdosing. 2006 felt stalked and intimidated at work. This caused anxiety and panic symptoms and needing psychiatry as well as psychology input. Noted that her younger sister died at a young age and there was childhood sexual abuse at age six from an employee of her parents.’ They noted that her mother was physically abusive and her father distant and unemotional. In the formulation, they noted that major trauma in her early life had led to a profoundly dismissing attachment pattern characterised by a need to do things herself, find others unhelpful or rejecting, a minimisation of feeling and focus on independence as well as achievement. She was discharged to the care of her husband.
In his report dated 27 August 2024, Dr Teoh detailed the circumstances of the injury. He noted an episode of depression in 2005 whilst employed as a paramedic. He recorded, “There was no family history of psychiatric illness or childhood trauma” contrary to the history in the documentation and to that provided by Ms Rinaudo. He noted he had examined Ms Rinaudo on 2 May 2022 and provided a psychiatric report. He did not revise his developmental history from the last report or comment on pre-existing conditions. No documents were listed for his review so it was unclear if he has received a copy of my initial Medical Assessment Certificate. He diagnosed a major depressive disorder. He noted she had reached maximum medical improvement. He assessed whole person impairment at 19% with self-care and personal hygiene at Class 2, social and recreational activities at Class 3, travel at Class 1, social functioning at Class 3, concentration, persistence and pace at Class 3 and employability at Class 5. I note his assessment of social functioning is inconsistent with the objective evidence. No deduction has been made for a pre-existing condition.
On 14 March 2024, in handwritten notes by her psychologist, I noted she was in Hervey Bay at the time, noting that she had a catch-up with her older sister today and will catch up again on Sunday. Suicide thoughts were noted. On 5 April 2024 she was noted to be going to the Twilight Markets in Hobart.
In correspondence dated 8 February 2024, Barry Gerhardt, Clinical Psychologist noted that Ms Rinaudo reported a past overdose, persistent pain; e.g. fibromyalgia and back pain, auditory hallucinations, stress, perfectionism, procrastination, sleep, past bullying, health, boundary, social, adjustment, paranoia, trust and low self-esteem issues; in addition to symptoms of anxiety and depression. He noted she continued to meet the DSM-5 criteria for a major depressive disorder and social anxiety in the presence of persistent pain.
On 17 January 2024 her GP Dr Richard Lawler noted that she was continuing therapy but had ongoing debilitating symptoms.
I noted on 15 December 2023 in handwritten notes by her psychologist that he husband was in jail for two weeks ‘after doing stupid things,’ noting, ‘Everyone in town has an opinion about what happened. Her life is shit’. Her psychologist notes she was visibly upset talking about the current situation. Persistent pain was noted repeatedly. Difficulties with a physical injury claimed through NSW WorkCover were noted on 8 September 2023.
In correspondence dated 4 July 2023, Mr Gerhardt that Ms Rinaudo reported that she seemed to have a target on her back for bullying all of her life, that she was still in a relationship with her husband Tony but she was distant and had trouble relating to him and recalled that at 9 years of age, she was living near Yass and ran away from home and could not recall why. He noted he had previous knowledge that she had a difficult childhood with a toxic mother who displayed narcissistic traits.
In June 2023, in handwritten notes, she was noted to have been to the Gold Coast with a friend, had a panic attack on a train and did not cope well with the trip.
In correspondence from her treating psychiatrist, Dr Phillip Reid, dated 11 May 2023, she was noted to continue to struggle. She switched medication from duloxetine to escitalopram. Her husband was due in court on 25 May 2023, and her mood was noted to be chronic with a diagnosis of major depressive disorder.
I note a reference in general practitioner notes by Dr Gerard McGushin dated 28 May 2015 to a “nasty call on GP Assist which has set off PTSD issues” and a recommendation to increase her antidepressant dose to 90 mg.
Correspondence dated 12 September 2019 by Dr Robert Dickson from Queenstown General Practice noted she had been attending the practice since 2010 and had several presentations with anxiety since 2013 and was commenced on an antidepressant in 2013, which was changed several times over the years.
In correspondence dated 17 March 2023, Dr Phillip Reid, treating psychiatrist, noted that on mental state examination, Tanya was depressed, and there seemed to be a number of factors in this with significant family disruptions in recent years. He referenced difficulties with her husband’s charges, chronic pain and the work-related injury. He noted she was chronically depressed on 11 May 2023. I note multiple references to fibromyalgia. I note references to shoulder problems. I note frequent references to post-traumatic stress disorder although the trauma meeting Criterion A for PTSD is not identified.”
The Medical Assessor gave the following reasoning for making a deduction of one-tenth under s 323 as follows:
“Is any proportion of loss of efficient use or impairment or whole person impairment, due to a previous injury, pre-existing condition or abnormality?
Yes. Ms Rinaudo has a history of recurrent depression associated with her adverse developmental history, a previous history of a work-related psychological injury, family stressors and pre-existing physical health conditions including a severe back injury and fibromyalgia that have had a substantial and ongoing effect on her day to day function, quality of life and mental health.”
He reasoned further as follows:
“DEDUCTION (IF ANY) FOR THE PROPORTION OF THE IMPAIRMENT THAT IS DUE TO PREVIOUS INJURY OR PRE-EXISTING CONDITION OR ABNORMALITY
(a) In my opinion the worker suffers from the following relevant previous injuries, pre-existing conditions or abnormalities:
(i)Major depressive disorder - recurrent.
(b) The previous injury, pre-existing condition or abnormality directly contributes to the following matters that were taken into account when assessing the whole person impairment that results from the injury, being the matters taken into account in 10a, and in the following ways:
(i)Ms Rinaudo has a confirmed history of recurrent major depressive episodes requiring psychological and medical treatment. She had a difficult upbringing, a history of childhood sexual abuse and pre-existing anxiety and depression requiring treatment. She had a work-related psychological injury. A history of major depressive episodes significantly increases the risk of subsequent episodes. Prior work-related depression and anxiety are salient to the current injury. She experienced suicidal thoughts in January 2019, approximately six months before she commenced employment in Wilcannia. She has a range of pre-existing physical conditions that are likely to have impacted her mood predating the injury, including major family stressors, chronic back pain and fibromyalgia. Her medical conditions have had a significant impact on her day-to-day function and quality of life.
(c) The extent of the deduction is difficult or costly to determine so in applying the provisions of s 323(2) I assess the deductible proportion as one-tenth.”
The extent of the deduction is complained about on appeal, the appellant submitting it should have been greater as a deduction of one-tenth is at odds with the available evidence.
The Medical Assessor explained his reasons for assessment under each of the PIRS categories as set out in the table above. The appellant complains that the Medical Assessor has erred in respect of two out of the six categories assessed, namely Social and Recreational Activities and social functioning. In both cases the appellant submitted that the assessments should have been of no deficit or Class 1 because the history taken is not congruent with the assessments made and are based on incorrect criteria.
The MAC must be read as a whole. The Appeal Panel cannot interfere with these ratings absent error by the Medical Assessor. The Appeal Panel cannot interfere with the rating because opinions might differ as to the best fit in each category. There must be error or assessment on the basis of incorrect criteria. The Appeal Panel will deal with each category complained about on appeal in turn.
In respect of Social and Recreational Activities, Table 11.2 of the Guides provides as follows:
Table 11.2: Psychiatric impairment rating scale – social and recreational activities
Class 1
No deficit, or minor deficit attributable to the normal variation in the general population: regularly participates in social activities that are age, sex and culturally appropriate. May belong to clubs or associations and is actively involved with these.
Class 2
Mild impairment: occasionally goes out to such events eg without needing a support person, but does not become actively involved (eg dancing, cheering favourite team).
Class 3
Moderate impairment: rarely goes out to such events, and mostly when prompted by family or close friend. Will not go out without a support person. Not actively involved, remains quiet and withdrawn.
Class 4
Severe impairment: never leaves place of residence. Tolerates the company of family member or close friend, but will go to a different room or garden when others come to visit family or flat mate.
Class 5
Totally impaired: Cannot tolerate living with anybody, extremely uncomfortable when visited by close family member.
The Medical Assessor assessed a moderate impairment at Class 3 with the following reasoning:
“Ms Rinaudo’s opportunities for social and recreational activities are in part limited by her location and lack of local friends. However, she continues socialising with her husband, stepdaughter, and grandchildren with weekly restaurant outings and outings for coffee with her husband. She regularly participates in craft. Outside of her immediate family she has few social outlets. She has stopped bible study. I note that her physical problems have significantly limited her capacity to socialise and engage in recreational activities, and more recently, there were difficulties related to her husband, which made it difficult for her to socialise locally.”
The appellant submitted that a Class 1 or no deficit should have been assessed.
The respondent submitted that the assessment of a moderate impairment was properly within the clinical judgment of the Medical Assessor who exercised his clinical expertise on the day of examination after taking a through history and that there was no error in the assessment by him of a moderate impairment in the domain of social and recreational activities which was also consistent with the Class assessed by Dr Teoh, the independent medical expert qualified to provide an opinion on behalf of the respondent worker.
The Appeal Panel considers there is an error in the rating of a moderate impairment. Given the history taken it could not possibly be said that the appellant is rarely undertaking social and recreational activities. She is going on weekly restaurant and coffee outings with her husband. She continues with a regular recreational activity of craft with her grandchildren. Her sister visits her several times a week, and they may go for coffee or watch a movie together once a week. She takes holidays with friends and family, e.g. she has been to Hervey for four days, travelled to Victoria without a support person to then make a four day trip Dandenong where “they enjoyed each other’s company”, and socialises with a friend whenever the friend is in town. In each of the psychologist’s most recent treatment session notes a new and different social and recreational activity is identified. Whilst she has stopped her bible study she is nonetheless actively involved in social and recreational activities that are regular as opposed to rare. The Medical Assessor points out that social and recreational activity has otherwise been limited by her physical limitations and a matter unrelated to injury that involves her husband. These limitations cannot be taken into account in rating impairment because of psychological injury. The Appeal Panel considers that there has been error in assessment of Class 3 which is incongruent with the history taken and has been made on the basis of incorrect criteria and that assessment on the basis of correct criteria gives a Class 2 or mild impairment rating for social and recreational activities.
In respect of Social Functioning, Table 11.4 of the Guides provides as follows:
Table 11.4: Psychiatric impairment rating scale – social functioning
Class 1
No deficit, or minor deficit attributable to the normal variation in the general population: No difficulty in forming and sustaining relationships (eg a partner, close friendships lasting years).
Class 2
Mild impairment: existing relationships strained. Tension and arguments with partner or close family member, loss of some friendships.
Class 3
Moderate impairment: previously established relationships severely strained, evidenced by periods of separation or domestic violence. Spouse, relatives or community services looking after children.
Class 4
Severe impairment: unable to form or sustain long term relationships. Pre-existing relationshipshe ended (eg lost partner, close friends). Unable to care for dependants (eg own children, elderly parent).
Class 5
Totally impaired: unable to function within society. Living away from populated areas, actively avoiding social contact.
The Medical Assessor assessed Class 2 with the following reasoning:
“Ms Rinaudo has lost some friendships. Her relationship with her husband is strained but intact. Her strained relationship with her children predated the injury. She continues to be actively involved with her stepdaughter’s children.”
The appellant submitted that the Medical Assessor should have assessed a Class 1 impairment.
The assessment by the Medical Assessor accords with Class 2. A mild impairment is the best fit as the respondent has maintained friendships as well as relationships with family members including with her husband albeit with some strain on the relationship. There has been some loss of friendships, this is consistent with the criteria for Class 2. The appeal panel can discern no error in the Class 2 rating.
In summary, the assessment of social functioning at Class 2 as assessed by the Medical Assessor have been confirmed on appeal. However there was error in the assessment for social and recreation activities which was assessed as Class 3, and should have been assessed as Class 2.
This means the calculations become as follows:
| Score | Median Class | ||||||||
| 1 | 2 | 2 | 2 | 3 | 5 | =2 | |||
| Aggregate Score Impairment | Total | % | |||||||
| 1+2 | +2 | +2 | +3 | +5 | 15 | 8% | |||
The appellant complained on appeal that the deduction under s 323 should have exceeded one-tenth as one-tenth was not consistent with available evidence which supports a greater deduction.
A deduction can only be made if the pre-existing condition abnormality or injury has contributed to the overall level of permanent impairment assessed. If the deduction is too difficult or costly to determine, the deduction should be one-tenth if that is not inconsistent with the available evidence.
The Appeal panel considers that the deduction of one-tenth is consistent with the available evidence that supports that the appellant’s pre-existing psychological condition was well under control, with little impairment and likely asymptomatic prior to her commencement of employment with the respondent and prior to the subject injury. The Medical Assessor noted specifically that ‘she said she recovered from her depressive symptoms related to her employment at Tjuntjunjara because she had good colleagues and managers and made friends with the teachers at the local school’. The Appeal panel can discern no error in the deduction of one-tenth made by the Medical Assessor.
This means that from the overall level of permanent impairment of 8% WPI a deduction of one-tenth is maintained, leaving 7% WPI as the total permanent impairment assessed because of the referred injury.
For these reasons, the Appeal Panel has determined that the MAC issued on
17 December 2024 should be revoked and a new MAC 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: | W8327-22 |
Applicant: | Tanya Rinaudo |
Respondent: | State of New South Wales (Far West Local Health District) |
This Certificate is issued pursuant to s 328(5) of the Workplace Injury Management and Workers Compensation Act1998.
The Appeal Pane revokes the Medical Assessment Certificate of Medical Assessor Clayton Smith and issues this new Medical Assessment Certificate as to the matters set out in the table below:
Table - whole person impairment (WPI)
| Body Part or system | Date of Injury | Chapter, page and paragraph number in NSW workers compensation guidelines | Chapter, page, paragraph, figure and table numbers in AMA5 Guides | % WPI | WPI deductions pursuant to S323 for pre-existing injury, condition or abnormality (expressed as a fraction) | Sub-total/s % WPI (after any deductions in column 6) |
| 1. Psycho-logical | 7/11/19 | 11, page 55-60 | 14 | 8 | 1/10 | 7 |
| Total % WPI (the Combined Table values of all sub-totals) | 7% | |||||
The above assessment is made in accordance with the SIRA NSW Guidelines for the Evaluation of Permanent Impairment for injuries received after 1 January 2002.
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