Trustees of the Roman Catholic Church for the Diocese of Newcastle-Maitland v Cutcliffe
[2024] NSWPICMP 487
•23 July 2024
| DETERMINATION OF APPEAL PANEL | |
| CITATION: | Trustees of the Roman Catholic Church for the Diocese of Newcastle-Maitland v Cutcliffe [2024] NSWPICMP 487 |
| APPELLANT: | Trustees of the Roman Catholic Church for the Diocese of Newcastle-Maitland |
| RESPONDENT: | Leonie Cutcliffe |
| APPEAL PANEL | |
| MEMBER: | John Wynyard |
| MEDICAL ASSESSOR: | Michael Hong |
| MEDICAL ASSESSOR: | Graham Blom |
| DATE OF DECISION: | 23 July 2024 |
| CATCHWORDS: | WORKERS COMPENSATION - Appeal by employer against psychological injury assessment; whether adequate reasons given for three psychiatric impairment rating scale categories; Wingfoot Australia Partners Pty Ltd v Kocak and El Masri v Woolworths Ltd applied; Held – reasons so sparse that path of reasoning is not clear; reasons not detailed enough for Medical Appeal Panel to see whether error made or not; worker re-examined; Medical Assessment Certificate revoked. |
BACKGROUND TO THE APPLICATION TO APPEAL
On 21 February 2024 Trustees of the Roman Catholic Church for the Diocese of Newcastle-Maitland, the appellant lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by Dr Gerald Chew, a Medical Assessor, who issued a Medical Assessment Certificate (MAC) on 1 February 2024.
The appellant relies on the following grounds of appeal under s 327(3) of the Workplace Injury Management and Workers Compensation Act 1998 (the 1998 Act):
· the assessment was made on the basis of incorrect criteria, and
· the MAC contains a demonstrable error.
The delegate is satisfied that, on the face of the application, at least one ground of appeal has been made out. The Appeal Panel has conducted a review of the original medical assessment but limited to the ground(s) of appeal on which the appeal is made.
Rule 128 of the Personal Injury Commission Rules 2021 (the PIC Rules) and Procedural Direction PIC7 - Appeals, reviews, reconsiderations and correction of obvious errors in medical disputes set out the practice and procedure in relation to the medical appeal process under s 328 of the 1998 Act. An Appeal Panel determines its own procedures in accordance with r 128(1) of the PIC Rules.
The assessment of permanent impairment is conducted in accordance with the SIRA NSW Workers Compensation Guidelines for the Evaluation of Permanent Impairment, 4th ed
1 March 2021 (the Guides) and the American Medical Association Guides to the Evaluation of Permanent Impairment, 5th ed (AMA 5). “WPI” is reference to whole person impairment.
RELEVANT FACTUAL BACKGROUND
On 22 November 2023 this matter was referred to the Medical Assessor for an assessment of WPI relating to a psychological/psychiatric caused by injury on a deemed date of 29 January 2020.
Ms Cutcliffe (the respondent) was employed as a secondary school art teacher. As a result of significant difficulties with students and management, including Ms Cutcliffe being filmed and being a meme on social media, she was not supported by management, she overdosed and ended up in hospital.
She saw a psychiatrist whilst there but has not seen one since.
The Medical Assessor awarded 44% WPI.
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 employer submitted that a re-examination was required and for the reasons given below a re-examination was arranged with the worker to see Dr Graham Blom on 24 June 2024, the demonstrable error being that we were unable to assess the Medical Assessor’s reasons as they were inadequate.
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 Graham Blom of the Appeal Panel conducted an examination of the worker on 24 June 2024 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 which 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 MAC
The MAC generally was difficult to assess because of the paucity of details given by the Medical Assessor in explaining his assessment.
His findings on physical examination were as follows:[1]
“Appeared her stated age. She was reasonably presented and groomed. Flat affect. Nil abnormal psychomotor activity. Depressed and anxious mood. Oriented to time, place and person. Speech of normal rate, rhythm, volume and prosody. Nil formal thought disorder. Nil delusions or hallucinations. No thoughts of harm to others. No suicidal ideation today or immediate plan.”
[1] Appeal papers page 21.
The Medical Assessor found that there was no insignificant inconsistency on presentation and advised that he based his assessment on the “history examination and collateral information.”
In the templated question at [10C] inviting brief comments regarding other medical opinions, the Medical Assessor noted that Dr Potter for the worker had assessed 50% WPI and that Dr Sivaruban had assessed 26% WPI.
The Medical Assessor noted that Dr Sivaruban’s assessment was more recent and he commented on three of the categories of Psychiatric Impairment Rating Scale (PIRS). He said:
“Areas of disagreement:
I note Dr Sivaruban’s assessment is more recent.
Self Care. She is class 2. She is able to live independently with only occasional help from her daughter.
Social functioning. I agree with Dr Potter’s assessment. There is loss of significant relationships, particularly her partner.
Concentration. I agree with Dr Sivaruban’s assessment. She is class 3 and cannot be class 4 as concentration deficits were not obvious through the interview.”
The Medical Assessor’s Table 11.8 rating form is reproduced.
Table 11.8: PIRS Rating Form
Name
Leonie Cutcliffe
Claim reference number (if known)
DOB
Age at time of injury
Date of Injury
Occupation at time of injury
Corrective Services
Officer
Date of Assessment
25/1/24
Marital Status before injury
Psychiatric diagnoses
PDD
Psychiatric treatment
GP, medication
Is impairment permanent?
Yes
PIRS Category
Class
Reason for Decision
Self Care and personal hygiene
2
She lives independently
Social and recreational activities
4
Reduced social functioning. Has withdrawn from social activities.
Travel
3
She can only leave the home accompanied.
Social functioning
4
Her husband has left.
She has no contact with friends.
Concentration, persistence and pace
3
Subjectively impaired concentration
No obvious difficulty during interview
Employability
5
Unable to work.
Score Median Class
2
3
3
4
4
5
4
Aggregate Score Impairment Total %
+
+
+
+
+
21
44%
SUBMISSIONS
The appellant employer submitted that the Medical Assessor had made his assessment on incorrect criteria firstly. The appellant employer challenged the social and recreational activities assessment, noting that although the Medical Assessor said that there was “reduced social functioning,” he failed to explain what social activities she had withdrawn from.
In relation to the category of social functioning, the appellant employer submitted that the history was inadequate to explain the class 3 rating. Although the Medical Assessor mentioned the separation from Ms Cutcliffe’s husband in November 2023, and that she had lost contact with friends, there were no details as to why the worker’s husband had moved out, nor were there any details relating to the nature of the relationships with her friends prior to her injury.
We were referred to the class 3 descriptors for this category and it was submitted that the “previously established relationships” which had become strained had not been defined.
The appellant employer constructed an argument that involved the provisions of s 322 (4) of the 1998 regarding maximum medical improvement. We were referred in that regard to a Medical Appeal Panel decision of Gower v State of New South Wales,[2] and to Chapters 1.15 and 1.16 of the Guides.
[2] [2018] NSWCA 132 at [20].
The appellant employer submitted that the finding that maximum medical improvement had been reached was inconsistent with Chapter 1.15 as the Medical Assessor found that Ms Cutcliffe’s treatment had been inadequate.
The appellant employer also referred to the descriptors for a class 4 rating in social functioning. It submitted that there was insufficient material to support the class 4 finding by the Medical Assessor.
The appellant employer concluded by submitting that the Medical Assessor had not provided “sufficient reasonings” and evidence for the ratings he gave in his Table 11.8 form.
This was so in relation to the categories of social and recreational activities and social functioning.
It was submitted again that no details of the social or recreational activities undertaken by Ms Cutcliffe prior to her injury were taken, neither had a history been taken about her prior social functioning and the relationships that were allegedly already established.
Respondent worker
Ms Cutcliffe sought to counter the appellant employer’s submissions as to lack of adequate reasoning by saying that the Medical Assessor stated that he based his assessment on the history, the examination and “collateral information.”
It was submitted that the collateral information would have included the medical reports and statements, and that it was not necessary for the Medical Assessor to recite each of the histories that he relied on. There was, it was submitted, sufficient evidence in the documents provided to the Medical Assessor to support the conclusions he reached.
As to the submission by the appellant employer that the Medical Assessor had erred in not finding that maximum medical improvement had not been achieved, Ms Cutcliffe pointed out that the injury occurred four years ago and the fact that she did not want to have treatment did not of itself mean that she had not reached maximum medical improvement.
Ms Cutcliffe repeated that there was sufficient material before the Medical Assessor to support his conclusions, repeating its submissions that it was enough for the Medical Assessor to have said that he based his assessment on “history, examination and collateral information.”
Discussion
We have referred to Vegan at the outset of these reasons as to the requirement of a Medical Assessor to give reasons, and that the detail of the reasons may vary according to the circumstances of each case. Whilst they need not be extensive or detailed, there is a minimum standard to be observed. In the well-known passage of the High Court in Wingfoot Australia Partners Pty Ltd v KocaK[3] it was held that the actual path of reasoning must be shown by which the assessment was made.
[3] [2013] HCA 43.
In El Masri v Woolworths Ltd [2014] NSWSC 144 Campbell J said:
“….. The obligation to give reasons is implied by the general law as explained in Campbelltown City Council v Vegan. What their Honours said at [55] of Wingfoot must be applicable. Basically the statement of reasons must explain that actual path of reasoning in sufficient detail to enable to court to see whether the opinion does or does not involve any error of law.”
The Appeal Panel was unable to divine the reasoning given by the Medical Assessor in either the body of the MAC itself or indeed the Table 11.8 rating form. The lack of detail in both prevents us from being able to determine how it was that the Medical Assessor reached his various assessments. The decision making by the Medical Assessor involved the exercise of discretionary power. Chapter 11.12[4] provides:
“Impairment in each area is rated using class descriptors. Classes range from 1 to 5, in accordance with severity. The standard form must be used when scoring the PIRS. The examples of activities are examples only. The assessing psychiatrist should take account of the person’s cultural background. Consider activities that are usual for the person’s age, sex and cultural norms.”
[4] Guides 55.
In Ferguson v State of New South Wales[5] Campbell J stated at [24]:
“The Appeal Panel also, with respect, correctly recorded that in accordance with Chapter 11.12 of the Guides ‘the assessment is to be made upon the behavioural consequences of psychiatric disorder, and that each category within the PIRS evaluates a particular area of functional impairment’: Appeal Panel reasons at [37]. The descriptors, or examples, describing each class of impairment in the various categories are ‘examples only’: see Jenkins v Ambulance Service of New South Wales.[6] The Appeal Panel said ‘they provide a guide which can be consulted as a general indicator of the level of behaviour that might generally be expected’: Appeal Panel reasons at [37].”
[5] [2017] NSWSC 887.
[6] [2015] NSWSC 633.
One or two line sentences simply lead to many unanswered questions when discretionary issues have to be considered. Indeed some of the Medical Assessor’s comments raised more questions than answers.
The appellant employer referred to the two phrases used to describe the reasons why a class 4 rating was given for social and recreational activities. “Reduced social functioning. Has withdrawn from social activities” begs more questions. What were the social activities that Ms Cutcliffe had withdrawn from ? in what way had Ms Cutcliffe’s social functioning reduced? Why did it warrant a class 4 rating and not any of the other ratings set out in the descriptors?
Similarly in social functioning there was no attempt to describe why Ms Cutcliffe’s husband left and whether it was connected to Ms Cutcliffe’s work, or whether there were other reasons involved. A simple statement “she has no contact with friends” is also insufficient to explain the class 4 rating given. It is equally applicable for other descriptors.
Although the appellant employer restricted its appeal to the two categories above, we note a similar paucity of reasoning in relation to the other categories.
We reject Ms Cutcliffe’s submission that the Medical Assessor’s comment that he had based his assessment on “collateral information” was sufficient to satisfy the requirement to give reasons. It would clearly be impossible for a party to be able to argue that an appeal was either tenable or not tenable if it did not know the precise basis on which determination was made.
The Medical Assessor erred in not providing adequate reasons for his assessments. We accordingly arranged for Ms Cutcliffe to be re-examined by Dr Graham Blom of the Appeal Panel on 24 June 2024. His report follows:
“Examination Conducted By: Graham Blom
Date of Examination: 24 June 2024
1. The workers medical history, where it differs from previous records
Ms Cutcliffe began working at St Pauls College in 2018, as a full-time visual arts teacher. She remained in this position for two years until she left due to the symptoms and impairment that she experienced as a result of a workplace injury. The injury occurred as a result of multiple episodes where Ms Cutcliffe felt humiliated, bullied and harassed in particular by the Leader of the Creative Arts and Languages Department is, as well as feeling unsupported by the senior management of the school. This situation was made worse when several students released an Instagram video, which she found insulting, derogatory and again extremely humiliating. Furthermore, she felt that the school principal and other management failed to take appropriate or reasonable action. As a result, she began to develop symptoms of significant anxiety, ruminations, panic attacks and markedly disturbed sleep with nightmares about the events at school. She left school on the 29 January 2020 and has not returned since. On the night following her last day at school, she had very significant anxiety and insomnia. She said that she was overwhelmed and began to take Panadeine because she had a headache and temazepam to assist her sleep. The next morning, she was unable to be roused and was admitted to hospital as she had taken an overdose of these medications. She said this overdose was accidental and she does not recall how much she had taken. In any case she found this a disturbing and again humiliating experience and said that she now is anxious at even the thought of going to hospital. She was admitted for a hysterectomy some months later, and as a result found this a disturbing experience as well.
Since ceasing her work, however her symptoms if anything have deteriorated. Her anxiety and panic became worse, her nightmares more frequent and more disturbing with resulting markedly disturbed sleep on top of insomnia, even without nightmares, as well as hypervigilance, irritability and feelings of being overwhelmed and unable to cope. She became increasingly withdrawn and avoidant because of feelings of shame, as well as anxiety at the thought of being confronted by people who would ask about her situation. As the months progressed, she became depressed with markedly low mood, repetitive tearfulness, loss of motivation and energy, disturbed concentration, focus and memory as well as feelings of increasing hopelessness and despair.
Soon after leaving work, she consulted her general practitioner and also began consulting a psychologist on a regular basis. She consulted the psychologist over approximately three years she said, on a frequent basis, initially weekly and then in the last year or so every fortnight. Despite this intensive treatment she felt that she did not improve and if anything deteriorated. She has regularly consulted her general practitioner since she left work and he has trialled her on a variety of medications, both antidepressants as well as the sedative antipsychotic agent quetiapine. At various times she has used varying degrees of benzodiazepine medications, especially temazepam, as well as codeine-based pain relief medication for headache.
Since her injury, because of the disorder that she has developed, Ms Cutcliffe said that she became increasingly avoidant and withdrawn. Within a short time of ceasing work, she became increasingly housebound and over the last couple of years very rarely leaves the house at all, except to attend general practitioner’s appointments or very occasionally for shopping. As a result, she said that her relationship with friends became strained and increasingly difficult. Now she says that her friends do not call her or visit. Her family visited in the first couple of years of her illness, but she found their presence disturbing because she said that she felt hounded by them and that they did not understand her and were not supportive. As a result, there was considerable conflict with her parents and her two sisters. This has led to significant strain in the relationships so that she said her sisters very rarely visit at all. I attempted to clarify when the last time was that they visited and she said that this was over six months ago. She said however at least one sister continues to keep in touch with her via SMS messaging. She said that her parents still drop in to see how she is going but these visits are difficult and often result in conflict. She does not go out recreationally at all she said, nor does she have any hobbies or other social contacts.
She lived with her husband and son at the time of her injury. But as her illness progressed there was increasing conflict between herself and her husband so that the relationships became increasingly strained and difficult. I asked why there was so much conflict and she said that her libido had virtually ceased, and this caused problems, and because of her nightmares her husband found it increasingly difficult to sleep in the same bed. He is a fireman with the New South Wales Fire Brigade and works shiftwork, so her restless sleep became increasingly problematical. As well he complained quite a lot that she ‘smelt and didn’t look after herself’. She said that they fought a lot, and that both cried a lot, but increasingly there was no connection between them. Her husband initially moved into a different bedroom, and then when the conflict did not stop, he moved out to live with his parents. I note that around this time her husband’s father was seriously ill and that he died soon after Mr Cutcliffe moved in. Subsequently, the parental home was sold and his mother, who is paraplegic moved into a nursing home in Sydney close to one of Mr Cutcliffe’s sisters. Since then, Mr Cutcliffe has moved into a granny flat/shed that is at the back of their home. Despite this she said that they only have perfunctory contact.
Just prior to her husband leaving, in November 2023 her son also moved out, in around September 2023, although it is not clear that this was directly as a result of her illness. He is also a firefighter and applied for a position in Air Services Australia as this allowed him to begin working in the air wing of the Fire Brigade. He is currently living in Alice Springs.
Ms Cutcliffe also has a daughter who is a radiographer and does locums around the state. She continues to have some contact with both of her children, although this is limited and there is conflict and strain in these relationships.
Additional history since the original Medical Assessment Certificate was performed
There has been no significant change in Ms Cutcliffe’s circumstances since the examination performed by the Medical Assessor in February of this year.
2. Current Symptoms.
Ms Cutcliffe symptoms have not changed over many months, although she feels that she probably was worse for some time after her husband left in November of last year. She continues to experience regular anxiety and occasionally panic. She is avoidant and withdrawn and virtually housebound. She regularly ruminates about what happened at school and either her ruminations or any reminders of her previous work can trigger her into panic. She has difficulties with sleep despite very considerable amounts of sedation, primarily waking during the night on two or three occasions most nights. Very often she is woken by bad dreams or occasionally nightmares. When she wakes from nightmares, she usually is anxious although approximately once every month she said she will wake having a full-blown panic attack. She tends to be generally hypervigilant, and easily startled. She also experiences regular headaches which she finds very difficult to tolerate.
She is tearful, feels down and lacks motivation and drive. Because of her sleep disturbance, she is fatigued and lacks energy. She tends to eat junk food and because of her lack of activity has gained weight. She feels hopeless and worthless but also irritated, frustrated and angry about what has happened to her. She voiced the complaint that people do not understand and are not supportive of her on multiple occasions. She described difficulties with concentration and focus and said that she can’t follow even simple TV shows. She denies suicidality, although says that she has had a few such thoughts in the past she has had none recently.
She had been consuming heavy amounts of alcohol at the time of her previous IMEs but said that in the last six months or so she has ceased using alcohol at all.
3. Current treatment.
Her medications are managed by her general practitioner, whom she consults on a monthly basis. Currently she is prescribed Desvenlafaxine, 100 mg/day. She also is prescribed quetiapine, 100 mg/night on a regular basis as well as 25 mg – 75 mg as required. She takes the 25 mg doses if she wakes during the night from nightmares and is unable to return to sleep because of anxiety. A couple of months ago she was begun on prazosin, 2–6mg/night. She said that since she has been started on the prazosin, her nightmares have reduced in frequency and intensity but as I have mentioned they continue. She also occasionally takes temazepam, although has limited this now to less than once/week. She has also been started on melatonin and takes 10 mg/night. She uses Panadeine, two tablets/night for headaches.
She had been diagnosed with hypothyroidism prior to her injury and is prescribed thyroxine for this. Her thyroid level is monitored on a three-monthly basis, by her GP.
Previously, she had been forgetful in taking her medication, but says that she now has a Dossett box and has been more consistent and regular in the intake of medication since then.
She is not having any psychological treatment currently and has not had any for over a year. She said that she does not wish to return to a psychologist as she found the treatment did not assist her and she believes that in fact caused a deterioration in her overall symptoms.
I raised the possibility of referral to a psychiatrist, or admission to a psychiatric unit for treatment. She was adamantly against this. She said that her general practitioner has discussed it with her in the past, but she does not wish to be treated by another doctor and was completely unwilling to consider admission to hospital. Generally, her feeling was that she wished not to be constantly ‘going over these things’ and felt that further treatment would inevitably result in this.
Findings on clinical examination
Ms Cutcliffe was seen via teleconference. The quality of the connection was good, and Ms Cutcliffe had no difficulty managing the app. I could only see her from her neck up. She had untidy, unkempt long blonde hair. She appeared to be approximately her stated age with no distinguishing marks.
She was tearful throughout the interview and generally distressed. When talking about treatment or even briefly touching on her experience at school she became agitated and further distressed. She repetitively returned to themes around feeling misunderstood, alone and hopeless.
She was clearly depressed with sadness and tearfulness prominent. Her affect however was not flattened. Themes related to feelings of guilt and anger were prominent and she voiced the thought on a couple of occasions that the injury had ‘ruined my life’. She was not suicidal at this interview. She presented as not just hopeless but also helpless with strong avoidant characteristics evident.
There was no evidence of psychotic phenomena.
Despite her subjective experience of substantial difficulty with concentration and focus she maintained reasonable focus through an interview that lasted just over one hour. Whilst she had difficulties with memory of chronological events she was nevertheless able to engage with the interview sufficiently for me to obtain a history.
4. Results of any additional investigations since the original Medical Assessment Certificate
NIL
5. Diagnosis.
1. Persistent depressive disorder with persistent Major depression.
2. Anxiety disorder – not otherwise specified.
The diagnosis of major depressive disorder is made because of the presence of low mood, loss of motivation and drive, significant avoidance and withdrawal, difficulties with concentration and focus, feelings of hopelessness worthlessness and inappropriate guilt, and occasional suicidal ideation. These symptoms have persisted for well over two years.
The diagnosis of Anxiety Disorder, not otherwise specified, is made because Ms Cutcliffe has symptoms typical of PTSD but the triggering injury, in no way meets the requirements for criteria A of this diagnosis – that is she has not been exposed to death or threatened death, serious injury or sexual violence. Nevertheless, she has are wide range of anxiety-based symptoms with a clear-cut traumatic quality.
We adopt Dr Blom’s report. We have determined the impugned categories as appears in the PIRS form below.
For these reasons, the Appeal Panel has determined that the MAC issued on 1 February 2024 should be revoked, and a new MAC should be issued. The new certificate is attached to this statement of reasons.
Table 11.8: PIRS Rating Form
Name
Leonie Cutcliffe
Claim reference number (if known)
DOB
Age at time of injury
Date of Injury
Occupation at time of injury
Corrective Services
Officer
Date of Assessment
25/1/24
Marital Status before injury
Psychiatric diagnoses
PDD
Psychiatric treatment
GP, medication
Is impairment permanent?
Yes
PIRS Category
Class
Reason for Decision
Self Care and personal hygiene
2
She lives independently
Social and recreational activities
4
She is markedly withdrawn, and has no social or recreational life. She continues to have some contact with her family and limited online contact with friends. She is virtually housebound.
Travel
3
She can only leave the home accompanied.
Social functioning
3
She maintains relationships with her children, her sister and her parents, albeit that they are strained and there is conflict, She still has some contact with her husband.
Concentration, persistence and pace
3
Unable to follow simple tv shows, maintained focus during interview, difficulty with memory of chronological events
Employability
5
Unable to work.
Score Median Class
2
3
3
3
4
5
3
Aggregate Score Impairment Total %
+
+
+
+
+
20
26%
WORKERS COMPENSATION DIVISION
APPEAL PANEL
MEDICAL ASSESSMENT CERTIFICATE
Injuries received after 1 January 2002
Matter number: | W8117/23 |
Appellant: | Trustees of the Roman Catholic Church for the Diocese Of Newcastle-Maitland |
Respondent: | Leonie Cutcliffe |
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 Gerald Chew 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) |
| Psychological | 29/1/20 deemed | Chapter 11 | N/A | 26 | Nil | 26 |
| Total % WPI (the Combined Table values of all sub-totals) | 26% | |||||
0
6
0