Strong v Woolworths Group Ltd

DETERMINATION OF APPEAL PANEL
CITATION:	Strong v Woolworths Group Ltd [2025] NSWPICMP 713
APPELLANT:	Cindy Dawn Strong
RESPONDENT:	Woolworths Group Limited
APPEAL PANEL
MEMBER:	Carolyn Rimmer
MEDICAL ASSESSOR:	Mohammed Assem
MEDICAL ASSESSOR:	James Bodel
DATE OF DECISION:	16 September 2025
CATCHWORDS:	WORKERS COMPENSATION - Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); assessment of impairment of the lumbar spine under DRE Lumbar Category III; Appeal Panel found that the applicant did not have cauda equina syndrome and there was no error in the assessment of the lumbar spine; Appeal Panel satisfied no error in assessment of activities of daily living; no assessment of scarring; Appeal Panel found error as claim was made in respect of scarring; worker re-examined and assessed at 1% whole person impairment (WPI) for scarring; Held – MAC revoked.

BACKGROUND TO THE APPLICATION TO APPEAL

On 29 May 2025 Cindy Dawn Strong (the appellant) lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by Dr David Lewington, a Medical Assessor, who issued a Medical Assessment Certificate (MAC) on
13 May 2025.
The appellant relies on the following grounds of appeal under s 327(3) of the Workplace Injury Management and Workers Compensation Act 1998 (the 1998 Act):
· the assessment was made on the basis of incorrect criteria, and
· the MAC contains a demonstrable error.
The delegate is satisfied that, on the face of the application, at least one ground of appeal has been made out. The Appeal Panel has conducted a review of the original medical assessment but limited to the ground(s) of appeal on which the appeal is made.
Rule 128 of the Personal Injury Commission Rules 2021 (the PIC Rules) and Procedural Direction PIC7 - Appeals, reviews, reconsiderations and correction of obvious errors in medical disputes set out the practice and procedure in relation to the medical appeal process under s 328 of the 1998 Act. An Appeal Panel determines its own procedures in accordance with r 128(1) of the PIC Rules.
The assessment of permanent impairment is conducted in accordance with the SIRA NSW Workers Compensation Guidelines for the Evaluation of Permanent Impairment, 4^th ed
1 March 2021 (the Guidelines) and the American Medical Association Guides to the Evaluation of Permanent Impairment, 5^th ed (AMA 5).

RELEVANT FACTUAL BACKGROUND

The appellant suffered an injury on 30 May 2020 in her employment as a check out operator/cashier with Woolworths Group Limited (the respondent).
The appellant lodged an Application to Resolve a Dispute (ARD) in the Personal Injury Commission (Commission) dated 24 February 2025 in which she claimed lump sum compensation in respect the injury to her lumbar spine.
The matter was referred to Dr David Lewington, Medical Assessor, for assessment of whole person impairment (WPI) of the lumbar spine as a result of the injury on 30 May 2020.
The Medical Assessor examined the appellant on 12 May 2025 and assessed 16% WPI in respect of the injury to the lumbar spine. The Medical Assessor deducted one tenth pursuant to s 323 of the 1998 Act, which resulted in an assessment of 14% WPI as a result of the injury on 30 May 2020.

PRELIMINARY REVIEW

The Appeal Panel conducted a preliminary review of the original medical assessment in the absence of the parties and in accordance with the Procedural Direction PIC7.
As a result of that preliminary review, the Appeal Panel determined that there was an error in the MAC and the appellant should undergo a further medical examination because there was insufficient information on which to make a determination.

EVIDENCE

Documentary evidence

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

Further medical examination

Dr James Bodel of the Appeal Panel conducted an examination of the appellant on
28 August 2025 and reported to the Appeal Panel.

Medical Assessment Certificate

The parts of the medical certificate given by the Medical Assessor that are relevant to the appeal are set out, where relevant, in the body of this decision.

SUBMISSIONS

Both parties made written submissions. They are not repeated in full but have been considered by the Appeal Panel.
The appellant’s submissions include the following:
(a)    ground 1 - incorrect criteria – the Medical Assessor notes that the appellant developed low limb symptoms and ultimately sphincter disturbance suggestive of either radicular and/or cauda equina involvement. He notes that an MRI scan of the 11 August 2020 found compression of the cauda equina likely related to CSF hypotension and exacerbated by L4/5 and L5/S1 disc herniation. L5/S1 and L4/5 prolapsed discs were treated by microdiscectomy at each level on
26 August 2020. After the surgery the lower limb symptoms reduced but those lower limb symptoms recurred as a result of a L5/S1 disc lesion, thought to be related to degenerative changes at L5/S1 together with some irritation of S1 nerve root;
(b)    whilst Associate Professor Ferch felt that urinary incontinence was unrelated to cauda equina or neurological problems, that was an opinion only. He does not say the disc disruption is not the cause of her bowel and bladder function. He simply says the disruption of such function is "not well explained" by the MRI scan;
(c)    Associate Professor Ghabrial finds that the disc disruption does explain and has caused those problems and assesses WPI accordingly. In that event, where one specialist is not clear but does not deny causation and another accepts causation, the clearer opinion should prevail;
(d)    in this event the appellant should be assessed in accordance with AMA 5 s 15.7 (PP395-398) where the appellant has "intermittent emptying without voluntary control of the bladder." She should be assessed as class 2 (10-24% WPI) in respect of bladder function and/or class 1 (1-19% WPI) in respect of anorectal impairment “(reflex regulation but only limited voluntary control);”
(e)    the appellant had persistent ongoing radicular pain and there is ample evidence spinal cord and/or cauda equina damage including bowel and bladder dysfunction so as to justify the assessment by Dr Ghabriel;
(f)    ground 2 - Demonstrable error – the Medical Assessor assessed the appellant as having 2% addition for activities of daily living (ADL's);
(g)    however, in her statement of 13 February 2025, the appellant says she "does not do much of anything", provides an extensive list of household and other domestic duties that she cannot do, and describes needing help to put her shoes on;
(h)    in accordance with the Guidelines at paragraphs 4.34 and 4.35 her capacity to undertake personal care activities such as dressing is affected and so the shoulder be a 3% addition for ADL's;
(i)    Associate Professor Ghabrial provides a 1% WPI assessment in relation to the scarring at the site of surgery. The Medical Assessor does not address the issue at all and a 1 % assessment should be made, and
(j)    summary - If the bowel and bladder effects are seen as related to the work injury, then the Medical Assessor’s assessment is wrong and Associate Professor Ghabrial's assessment should be preferred. The ADL figure is incorrect and the scarring figure should be included.
The respondent’s submissions include the following:
(a)    the first ground of appeal is misguided as the Medical Assessor had no jurisdiction to assess bladder/bowel dysfunction. Bladder and bowel dysfunction was not referred for assessment. The ARD only made a claim in respect of the lumbar spine. The Referral on 18 March 2025 provided: “systems claimed: Lumbar Spine, Method of assessment: Whole Person Impairment.” The appellant did not at any stage seek to amend or correct the terms of this referral;
(b)    although one may look beyond the referral as to the true nature of a medical dispute, the terms of the referral cannot be ignored, thus confining a medical assessment to the scope of the referral: In Skates v Hills Industries Ltd [2021] NSWCA 142 (Skates); Yates v Flavorjen Pty Ltd [2022] NSWSC 388;
(c)    although the appellant asserts the Medical Assessor should have assessed a consequential condition to the lumbar spine in accordance with s15. 7 of the AMA-5, the Medical Assessor was not obligated to do so. The condition of cauda equina syndrome affects separate body systems (bladder/bowel) and should have been pleaded accordingly;
(d)    the Medical Assessor is bound by the specific terms of the medical referral and body systems pleaded in the ARD. Only the lumbar spine was subject of the referral. As such, the DRE method of assessment is correct;
(e)    the Medical Assessor was not required and not permitted to assess impairment of the bladder/bowel;
(f)    there is medical opinion on cauda equina syndrome. The appellant conceded there was ambiguity as to causation and goes to whether there ought to be finding of “injury” resulting from the lumbar spine injury. If accepted, it would lead to a situation where a Medical Assessor is required to determine a legal question, which is the exclusive domain of a Member;
(g)    it matters not if there is "ample evidence" of spinal cord and/or cauda equina damage, as purported by the appellant. The respondent relied on the appellant's pleadings as the basis for the claim and allowed the referral to proceed, as pleaded. The cauda equina syndrome was not a matter put before the PIC for determination as a precursor to a Medical Assessment. Therefore, the appellant's submission can be given no weight;
(h)    the Medical Assessor is not bound to follow the opinion of other experts whose opinions are in evidence before him;
(i)    the Medical Assessor cannot fall into error by failing to make an assessment which was not subject of the medical referral, or for not following the methodology applied by Associate Professor Ghabrial. This is particularly so noting Associate Professor Ghabrial had made a methodological error in his own assessment which is explained by the Medical Assessor at page 6 of the MAC;
(j)    the Medical Assessor has applied the correct criteria within the scope of the medical referral;
(k)    ground 2 – ADLs and scarring - the Medical Assessor’s assessment of 2% WPI for ADLs is based on the appellant's self-reporting, as well as his own clinical findings. The Medical Assessor is obliged to review the appellant's statement but is not bound by it. At paragraph 9 of the MAC, the Medical Assessor confirmed the "patients' statement" formed the facts upon which his assessment was based;
(l)    it is sufficient that a Medical Assessor obtain their own history on activities of daily living from the appellant, rather than simply adopting her statement
(GIO v Amos [2024] NSWCA 65). The MAC demonstrates the Medical Assessor provided his assessment based on the history obtained on the day of examination and his clinical judgment, disclosing no error. The Medical Assessor's assessment of 2% WPI was reasonably available to him;
(m)     finally, the respondent opposes any allowance for scarring. The ARD and the medical referral omitted any reference to TEMSKI and the Medical Assessor is bound by the terms of the referral (Oswell v Sublime Install Pty Ltd [2023] NSWPICMP 570), and
(n)    the MAC of 14% WPI should be confirmed and the appeal dismissed.

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 Appeal Panel has reviewed the MAC and evidence in this matter.

Ground 1- incorrect criteria - failure to assess bladder and anorectal impairment under 15. 7 of the AMA-5

The appellant submits that the appellant should be assessed in accordance with AMA 5 Part 15.7 where the appellant has "intermittent emptying without voluntary control of the bladder" and as class 2 (10-24% WPI) in respect of bladder function and/or class 1 (1-19% WPI) in respect of anorectal impairment “(reflex regulation but only limited voluntary control).” The appellant argues that she has persistent ongoing radicular pain, particularly in the left leg and ongoing sharp low back pain radiating to the right buttock, which is ample evidence spinal cord and/or cauda equina damage including bowel and bladder dysfunction so as to justify the assessment by Associate Professor Ghabrial.
In the MAC, the Medical Assessor noted that there was development of low back pain in the course of the applicant’s normal duties since approximately November 2010 involving recurrent lifting and scanning of grocery items. He noted that symptoms worsened over a busy period in 2020. The Medical Assessor reported that the applicant developed lower limb symptoms and ultimately some sphincter disturbance suggestive of either radicular and/or cauda equina involvement.
The Medical Assessor noted that the treating neurologist, Dr Pavey, in correspondence dated 30 July 2020, referred to the MRI Scan of the lumbosacral spine on 11 August 2020 which found compression of the cauda equina likely related to C.S.F hypotension and exacerbated by L4-5 and L5-S1 disc herniation.
The Medical Assessor noted that on 26 August 2020 the applicant underwent decompression surgery for disc lesions at the L4-5 and L5-S1 levels. He reported that the Discharge Summary from John Hunter Hospital noted "radiculopathy, chronic low back pain, V.P shunt in place" and L4-5 and L5 -S1 microdiscectomies were performed and complicated by possible V.P over shunting. The Medical Assessor noted that the operation report of 26 August 2020 reported left L5 and S1 radiculopathy on MRI, left L5 -S1 and L4-5 prolapsed intervertebral disc with microdiscectomy performed at both levels.
The Medical Assessor noted that her ventriculoperitoneal shunt continued to cause headaches and other symptoms and on 14 October 2020 she was admitted to John Hunter Hospital for closure of the shunt. The operation report from the 14 October 2020 confirmed that the shunt was tied off due to over shunting.
The Medical Assessor noted that follow-up consultations from neurologist, Dr Pavey, on
15 October 2020 noted dramatic improvement in lower limb symptoms. He noted that in the consultation on 5 March 2021, Associate Professor Ferch, neurosurgeon, also commented that lower limb symptoms had greatly improved since the microdiscectomies and she no longer had left leg pain.
The Medical Assessor wrote:
“Consultation with neurosurgeon Dr Ferch 27 July 2023 confirms no recurrence of hydrocephalus but recurrence of an L5-S1 disc lesion with left leg pain, subsequently thought to be related to degenerative changes at the L5-S1 level with some irritation of the S1 nerve root. Symptoms of urinary incontinence were felt to be unrelated to a cauda equina or neurological problems i.e. unrelated to the spine and consultation with a urologist (bladder specialist) was recommended. MRI Scan confirmed that there was no neurological compromise to the nerves controlling bowel and bladder function. Revision surgery for the L5 -S1 was discussed but did not proceed.”
Under “Present symptoms” the Medical Assessor noted that the appellant had ongoing sharp low back pain which radiated to the right buttock and was associated with general numbness of the left leg and overall weak feeling of the left leg. He noted that the appellant described symptoms of stress incontinence with movements or coughing, et cetera. He noted that a urological consultation had been recommended but had not occurred.
The Medical Assessor made the following diagnosis:
“Decompression lumbar spine microdiscectomies at the L4-5 and L5-S1 levels on a background of a ventriculoperitoneal shunt. Features of persisting left S1 radiculopathy.”
The Medical Assessor, in commenting on the report of Dr Ghabriel, wrote:
“Dr Ghabrial,(sic) orthopaedic surgeon medicolegal report 22 April 2024: assessed lumbar spine DRE Category V, 25% W.P.I with 3% A.D.L contribution. No deductible proportion. There is methodological error as the IME based DRE Category 5 on "bladder and bowel incontinence and residual marked pain in the back and radiculopathy". Urinary bladder and bowel incontinence is not at all considered under Table 15 - 3 under any DRE lumbar category and DRE Category V requires a combination of radiculopathy and alteration of motion segment integrity (which has not been pleaded nor is in clinical evidence). Furthermore, the clinical evidence is also against a spine-related urinary bladder and bowel impairment and the IME does not set out examination findings or investigations that would otherwise support a spine-related impairment such as cauda equina involvement.”
Associate Professor Richard Ferch, treating neurosurgeon, in a report dated 27 July 2023 noted that the applicant underwent discectomy surgery on 26 August 2020 which resulted in a substantial improvement in her left lower limb pain for 12 months but following that she developed increasing pain in her leg. He noted that she had been troubled by urinary incontinence. He wrote: “She has preserved sensation over her perineum but is also aware of fecal spiling. She did not frankly experience fecal incontinence.”
Associate Professor Ferch expressed the opinion that the appellant’s “urinary incontinence was not typical of cauda equina compression and she would benefit from a review through a urologist. It is possible that local bladder factors are contributing to her urinary symptoms.”
Associate Professor Ferch in a report dated 31 August 2023 reviewed a recent MRI scan and noted that there could be some irritation of the descending S1 nerve root. He wrote:
“There is no compromise to the nerves controlling bowel and bladder function… Cindy's bowel and bladder symptoms are not well explained on the basis of her MRI scan. She may benefit from further investigation through a urologist.”
Associate Professor Ghabriel, in a report dated 22 April 2024 wrote:
“As mentioned previously, following the injury of 2020 and prior to surgery she
developed bladder and bowl incontinence which continued to deteriorate over the
years.
The problem to date is recurrent left L4/5 disc herniation. Again she reported that her bladder and bowel incontinence became worse.”
Associate Professor Ghabriel made the following assessment of WPI:
“The whole person impairment regarding the lumbar spine is assessed at 28%, according to DRE Lumbar Category 5, due to bladder and bowel incontinence and residual marked pain in the back and radiculopathy in the legs.
The whole person impairment regarding a scar is assessed at 1%, according to TEMSKI.”
While it can be inferred from Associate Professor Ghabrial’s report that he was of the view the disc disruption did cause the bladder and bowel incontinence, he did not the assess WPI accordingly. Dr Ghabriel made the assessment according to Table 15.3 of AMA 5 for DRE Lumbar Category 5, due to “bladder and bowel incontinence and residual marked pain in the back and radiculopathy in the legs.” Dr Ghabriel did not make an assessment under Part 15.7 of AMA 5 and Table 15.6.

Table 15.3 of AMA 5 requires the following criteria for an assessment of DRE Lumbar Category V:
“ Meets the criteria of DRE lumbosacral categories III and IV, that is, both radiculopathy and alteration of motion segment integrity are present, significant lower extremity impairment is present as indicated by atrophy or loss of reflexes, pai and /or sensory changes within an anatomic distribution (dermatomal), or electromyographic findings as stated in lumbar category III and alteration of spine motion segment integrity as defined in lumbosacral category IV
or
fractures: (i) greater than 50% compression of one vertebral body with unilateral neurological compromise.”
The Guidelines at cl 4.6 provide:
“If a person has spinal cord or cauda equina damage, including bowel, bladder and/or sexual dysfunction, he or she is assessed according to the method described in AMA 5 Section 15.7 and AMA 5 Table 15.6 (a) - (g) (pp 395-98).”
The Guidelines at cl 4.22 and cl 4.23 provide:
“4.22 The cauda equina syndrome is defined in Box 15.1 in Chapter 15 of AMA5 (p 383) as ‘manifested by bowel or bladder dysfunction, saddle anaesthesia and variable loss of motor and sensory function in the lower limbs’. For a cauda equina syndrome to be present there must be bilateral neurological signs in the lower limbs and sacral region. Additionally, there must be a radiological study which demonstrates a lesion in the spinal canal, causing a mass effect on the cauda equina with compression of multiple nerve roots. The mass effect would be expected to be large and significant. A lumbar MRI scan is the diagnostic investigation of choice for this condition. A cauda equina syndrome may occasionally complicate lumbar spine surgery when a mass lesion will not be present in the spinal canal on radiological examination.
4.23 The cauda equina syndrome and neurogenic bladder disorder are to be assessed by the method prescribed in the spine chapter of AMA 5 Section 15.7 (pp 395–98). For an assessment of neurological impairment of bowel or bladder, there must be objective evidence of spinal cord or cauda equina injury.”
The Appeal Panel notes the appellant submits that she should be assessed in accordance with AMA 5 Section 15.7 (as she has "intermittent emptying without voluntary control of the bladder” and "reflex regulation but only limited voluntary control)." The appellant argues that she has persistent ongoing radicular pain and there is ample evidence spinal cord and/or cauda equina damage including bowel and bladder dysfunction so as to justify the “Ghabrial assessment.”
The Appeal Panel rejects this submission. Firstly, Associate Professor Ghabriel did not make a diagnosis of cauda equina syndrome. Secondly, noting the requirements in the Guidelines at 4.22, there is insufficient evidence that the appellant has cauda equina syndrome. In particular, there is no evidence that she has saddle anaesthesia, variable loss of motor and sensory function in the lower limbs, and bilateral neurological signs in the lower limbs and sacral region. The examination findings of the Medical Assessor reveal that the appellant has neurological signs in the left lower extremity not bilaterally. Further, there is no radiological study which demonstrates a lesion in the spinal canal, causing a mass effect on the cauda equina with compression of multiple nerve roots.
The Appeal Panel agrees with the Medical Assessor’s opinion that the clinical evidence is against a spine-related urinary bladder and bowel impairment. The Appeal Panel also notes that Associate Professor Ghabriel did not set out examination findings or investigations that would otherwise support a spine-related impairment such as cauda equina involvement.
The Appeal Panel finds no error in the assessment of the lumbar spine made by the Medical Assessor. There was no application of incorrect criteria in the assessment. In the absence of a cauda equina syndrome, the appellant was assessed appropriately under Lumbar Category DRE III.
This ground of appeal is not made out.

Ground 2 – failure to assess ADLs and scarring

Assessment of ADLs

The appellant argues that in accordance with the Guidelines at cls 4.34 and 4.35 her capacity to undertake personal care activities such as dressing is affected and so there should be a 3% addition for ADLs.
The Medical Assessor assessed the appellant as having 2% addition for activities of daily living (ADLs).
The Medical Assessor under “Social Activities/ADL” wrote:
“Lives in a three-bedroom villa with her husband and 22 year old son. She has difficulty with heavier housework chores such as vacuuming, making beds, cleaning floors or any task involving crouching or bending.”
Under “Summary of injuries and diagnoses: the Medical Assessor wrote:
“Decompression lumbar spine microdiscectomies at the L4-5 and L5-S1 levels on a background of a ventriculoperitoneal shunt. Features of persisting left S1 radiculopathy.”
The Medical Assessor added 2% impairment for ADL restrictions in accordance with paragraphs 4.33 - 4.38, pages 27-28, of the Guidelines. He wrote:
“I consider this percentage to be commensurate with the level of impairment. Regarding the latter, it is noted under Paragraph 4.33, that Paragraphs 4.34 and 4.35 are to be used as guides only and that ADL is not solely dependent on self-reporting but is based on all clinical findings and other reports.”
In her statement of 13 February 2025, the appellant wrote:
“I can care for myself mainly but I do often get help putting shoes on. I often have to ask my son to help me with this.”
The Appeal Panel accepts that in her statement dated 13 February 2025 the appellant provides an extensive list of household and other domestic duties that she cannot do and describes often needing help to put her shoes on. However, she does not describe any other problems with personal care activities.
The Appeal Panel noted that Associate Professor Ghabriel did not comments on ADLs. Associate Professor Paul Miniter assessed 2% for ADLs in his report dated 13 January 2025.
Associate Professor Leon Kleinman, consultant orthopaedic surgeon, in a report dated 18 March 2022 noted that the appellant required assistance with dressing and undressing and putting on shoes and socks. He assessed 3% for ADLs but the Appeal Panel notes that this assessment was performed more than 3 years ago and it would appear that the appellant ability to dress and undress has improved since then.
The Appeal Panel is not persuaded that the Medical Assessor erred in his assessment of 2% for ADLs or that the assessment was made on the basis of incorrect criteria. The only issue with self-care described by the appellant in her statement dated 13 February 2025 is that she often has to ask her son to help put on her shoes. In the view of the Appeal Panel one isolated area of dysfunction from time to time in self-care is not sufficient to warrant an assessment of 3%. The Medical Assessor was required to consider the overall impact of interference with ADLs. Further, the assessment is not solely dependent on self-reporting, but takes take into account her evidence, history, and the findings on examination.
This ground of appeal is not made out.

Assessment of scarring

The appellant submits that Associate Professor Ghabrial provided a 1% WPI assessment in relation to the scarring at the site of surgery but the Medical Assessor did not address the issue at all. The appellant argues that a 1% assessment should be made.
The Appeal Panel accepts that the claim was lump sum compensation was made based on the assessment of Associate Professor Ghabrial. Associate Professor Ghabriel in his report of 22 April 2024 made an assessment of 29% WPI, combining 28% WPI for the lumbar spine and 1% WPI for scarring.
The Appeal Panel accepts that in the ARD no reference was to skin or scarring in the systems claimed and only to the lumbar spine. However, the claim was made in respect 29% WPI.
The referral to the Medical Assessor identified the body parts referred as the lumbar spine.
It appears that the appellant made no objection to the terms of the referral.
In Skates both Leeming and McCallum JJA stating that what is referred for assessment by a Medical Assessor was the “medical dispute” not body parts. The observations of the Court of Appeal in Skates, confirmed that the exchange of correspondence and medical evidence relevant to the claim, identified the scope of the medical dispute.
In Skates at [47]-[48], Leeming JJA stated:
“47. Sections 321 and 321A concern referrals of a dispute for assessment. The language of the heading of each section commences ‘Referral of medical dispute’ and each provision confirms that it is the medical dispute which is referred for assessment. Section 293 authorises the referral of a medical dispute for medical assessment and the deferral of determination of the dispute. All these provisions proceed on the basis that the outcome of the assessment is the resolution of the medical dispute. So too does the conclusive presumption of correctness accorded by s 326 to assessments which are certified in a medical assessment certificate.
48. The paperwork associated with the administration of the legislation seems to have led to a tendency to give to the document comprising the ‘referral’ to an Approved Medical Specialist a greater status than it warrants. The document is important. However, the fundamental legal concept is a dispute. In the absence of a dispute, the worker and the insurer would not need to go to the Commission.”
At [81] McCallum JA stated that:
“81. … But more importantly, the focus on body parts is apt to distract attention from the precise matter to be assessed and certified by the approved medical specialist. Parts 4 and 5.6 of the application to resolve a dispute had to be read together and in the context of the statutory regime explained above. The legislation contemplates the referral of a ‘medical dispute’, being one of the matters specified in s 319 (here, the degree of permanent impairment of the worker as a result of his injuries). Part 4 of the application specified the relevant injuries; part 5.6 specified the body systems claimed to have impairment as a result of those injuries.”
On balance, the Appeal Panel considers that a fair reading of the appellant’s claim, its supporting documentation and the ARD would plainly reveal the bounds of the dispute, namely, whole person impairment of the lumbar spine and scarring following surgery to the lumbar spine. Therefore, the Appeal Panel considers that the Medical Assessor erred in failing to assess scarring.
This ground of appeal is made out.
The Appeal Panel notes that although Associate Professor Ghabrial assessed 1% for scarring, he provided no description of the scar and made no reference to criteria in Temski scale. The only description of the scar was provided by Associate Professor Miniter, who noted in his report of 15 November 2021 that the appellant had a “well healed surgical scar in the posterior spinal region.”
Clause 14.6 of the Guidelines provides:
“A scar may be present and rated as 0% WPI.
Note that uncomplicated scars for standard surgical procedures do not, of themselves, rate an impairment.”
There was no reference to scarring in the appellant’s statement:
Associate Professor Kleinman and the Medical Assessor made no reference to scarring.
The Appeal Panel, having found error, concludes that it was necessary for the appellant to undergo a further medical examination because there was insufficient evidence on which to make a determination in respect of an assessment of scarring.
As noted above Medical Assessor James Bodel of the Appeal Panel examined the appellant on 28 August 2025. Medical Assessor Bodel provided the following report:
“The workers medical history, where it differs from previous records
Ms Strong was assessed by Dr David Lewington on 12 May 2025. There is nothing new or different in the history that has been recited in his Medical Assessment Certificate.
Ms Strong confirms that the history relating to the injury is accurately recorded.
Additional history since the original Medical Assessment Certificate was performed
Nil.
Findings on clinical examination
The Appeal Panel have determined that all that needs to be re-assessed in this circumstance is the scarring.
There is a mid-line lumbar scar. The characteristics of the scar in accordance with the TEMSKI scale are as follows.
The scar is approximately 7cm in length.
The claimant is conscious of its existence. She is able to place her hand on the scar, although it is in the middle of her lower back. The anatomical location is the lower part of the back and is covered by normal clothing. There is some irritation of the scar from tight-fitting clothing around that area.
There is some slight pigmentation in part of the scar, with colour contrast between the scar and surrounding skin.
There are some minimal trophic changes, with some slight hypertrophy at the top end of the scar.
The suture marks are visible.
There are minor contour defects with some loss of subcutaneous tissue.
There is a negligible effect on any of the activities of daily living in regard to the scar itself.
There is no sign of adherence.
I rate this scar, as a 1% Whole Person Impairment under the TEMSKI scale.
Results of any additional investigations since the original Medical Assessment Certificate
Nil, relating to the area of injury and in particular.
Nil, relating to the re-assessment of the scar.”
The Appeal Panel adopts the report and findings of Medical Assessor Bodel.
The Appeal Panel assesses the appellant having 1% WPI for scarring. The Appeal Panel combined 1% WPI with 14% WPI assessed in respect of the lumbar spine which resulted in a total of 15% WPI.
For these reasons, the Appeal Panel has determined that the MAC issued on 13 May 2025 should be revoked, and a new MAC should be issued. The new certificate is attached to this statement of reasons.

WORKERS COMPENSATION DIVISION

APPEAL PANEL

MEDICAL ASSESSMENT CERTIFICATE

Injuries received after 1 January 2002

Matter number:	W2116/25
Applicant:	Cindy Dawn Strong
Respondent:	Woolworths Group Limited

This Certificate is issued pursuant to s 328(5) of the Workplace Injury Management and Workers Compensation Act1998.

The Appeal Panel revokes the Medical Assessment Certificate of Medical Assessor David Lewington and issues this new Medical Assessment Certificate as to the matters set out in the Table below:

Table- whole person impairment (WPI)

Body Part or system	Date of Injury	Chapter, page and paragraph number in NSW workers compensation guidelines	Chapter, page, paragraph, figure and table numbers in AMA 5 Guides	% WPI	Proportion of permanent impairment due to pre-existing injury, abnormality or condition	Sub-total/s % WPI (after any deductions in column 6)
1.Lumbar spine	30 May 2020	DRE Chapter 4 page 26 Table 4.1 ADL pages 27-28 paras 4.33- 4.36 Effects of surgery para 4.27 Table 4.2 Radiculopathy Page 27 paras 4.27-4.29	Chapter 15 page 384 Table 15-3 Page 382 Box 15-1	16%	1/10th	14%
2.Scarring	30 May 2020	Chapter 14 Table 14.1	1%	Nil	1%
Total % WPI (the Combined Table values of all sub-totals)					15%

[2025] NSWPICMP 713

16 September 2025