Whiteley v MH Management (NSW) Pty Ltd
[2024] NSWPICMP 86
•21 February 2024
| DETERMINATION OF APPEAL PANEL | |
| CITATION: | Whiteley v MH Management (NSW) Pty Ltd [2024] NSWPICMP 86 |
| APPELLANT: | Amanda Whiteley |
| RESPONDENT: | MH Management (NSW) Pty Ltd |
| APPEAL PANEL | |
| MEMBER: | Catherine McDonald |
| MEDICAL ASSESSOR: | Douglas Andrews |
| MEDICAL ASSESSOR: | Michael Hong |
| DATE OF DECISION: | 21 February 2024 |
| CATCHWORDS: | WORKERS COMPENSATION - Workplace Injury Management and Workers Compensation Act 1998; psychological injury; Medical Assessment Certificate (MAC) so brief as to fail to disclose Medical Assessor’s path of reasoning; internally inconsistent; re-examination required; Held – MAC revoked. |
BACKGROUND TO THE APPLICATION TO APPEAL
On 20 October 2023 Amanda Whiteley 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 5 October 2023.
Ms Whiteley 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 was satisfied that, on the face of the application, at least one ground of appeal was made out. We conducted a review of the original medical assessment, 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).
RELEVANT FACTUAL BACKGROUND
Ms Whiteley suffered a psychological injury on 21 November 2017 as a result of working permanent night shift at a resort operated by MH Management (NSW) Pty Ltd (MH Management).
In a brief MAC, the Medical Assessor assessed 9% whole person impairment (WPI) under the Psychiatric Impairment Rating Scale (PIRS), placing Ms Whiteley in class 2 for self care and personal hygiene, social and recreational activities, travel and social functioning. He assessed Ms Whiteley in class 3 for concentration, persistence and pace and class 5 for employability.
PRELIMINARY REVIEW
We 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, we determined that Ms Whiteley should undergo a further medical examination because the MAC was so brief as to fail to disclose the Medical Assessor’s path of reasoning for his assessment of the PIRS classes in respect of which Ms Whiteley appealed.
EVIDENCE
We have all the documents that were sent to the Medical Assessor for the original medical assessment and have taken them into account in making this determination.
Dr Andrews of the Appeal Panel conducted an examination of the worker on 7 February 2024 and reported to us. His report forms part of these reasons.
The parts of the MAC 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 we have considered them.
In summary, Ms Whiteley submitted that the MAC is lacking in sufficient reasoning to explain how he placed her in class 2 in the PIRS tables for self care and personal hygiene and social and recreational activities.
With respect to self care and personal hygiene, Ms Whiteley said that the Medical Assessor did not provide the facts on which he based his assessment, nor explain why he preferred the opinion of Dr Chowdry, qualified for MH Management, to that of Dr Allan, qualified on her behalf. In particular, he did not set out the information he obtained as to how often she washes.
With respect to social and recreational activities, Ms Whiteley noted that she travels to Seal Rocks for a holiday each January and that she has friends who visit. She said there was “no evidence” that she attended social events without a support person or that she did not remain quiet and withdrawn. There was a paucity of reasoning and Ms Whiteley said class 3 should have been allocated.
Ms Whiteley also said that there was a demonstrable error because the Medical Assessor said there was “inconsistency between her subjective account and the social media investigation report” but that inconsistency was not brought to her attention.
In reply, MH Management said that classes 2 and 3 for self care and personal hygiene were “defined” in the Guidelines and that the Medical Assessor had taken an adequate history from Ms Whiteley and referred to the histories provided to Drs Allan and Chowdry. MH Management said that there was no error in the Medical Assessor’s assessment. It made substantially the same submissions with respect to social and recreational activities and said that assessment in class 2 was appropriate “given the Appellant’s presentation during the examination”.
MH Management said it was unaware of any social media investigation report and said that the reference may be a typographical error. It said that the comment was not a demonstrable error because it had no impact on the impairment assessment. It said that the assessment was open to the Medical Assessor.
FINDINGS AND REASONS
The procedures on appeal are contained in s 328 of the 1998 Act. The appeal is 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 Queanbeyan Racing Club Ltd v Burton,[1] the Court of Appeal held that an Appeal Panel is not limited to the ground held to have been made out by the delegate but may consider all grounds of appeal raised in the application. However, the panel is not permitted to look for errors which are not part of the grounds of appeal on which the appeal is made. We have only considered those grounds specifically raised by Ms Whiteley.
[1] [[2021] NSWCA 304 at [26].
In Campbelltown City Council v Vegan[2] the Court of Appeal held that an Appeal Panel is obliged to give reasons. Where there are disputes of fact it may be necessary to refer to evidence or other material on which findings are based, but the extent to which this is necessary will vary from case to case. Where more than one conclusion is open, it will be necessary to explain why one conclusion is preferred. On the other hand, the reasons need not be extensive or provide a detailed explanation of the criteria applied by the medical professionals in reaching a professional judgement.
[2] [2006] NSWCA 284.
The MAC
It must be said that the MAC is exceptionally brief. The Medical Assessor set out a truncated history of the injury, treatment, present symptoms and previous conditions.
The requirements for the preparation of a medical report appear in paragraphs 1.46 to 1.51. of the Guidelines. They are also relevant to the preparation of a MAC and reference to them highlights the ways in which this MAC is deficient. The Guidelines provide:
“1.46 A report of the evaluation of permanent impairment should be accurate, comprehensive and fair. It should clearly address the question(s) being asked of the assessor. In general, the assessor will be requested to address issues of:
·current clinical status, including the basis for determining maximum medical improvement
·the degree of permanent impairment that results from the injury/condition, and
·the proportion of permanent impairment due to any previous injury, pre-existing condition or abnormality, if applicable.
1.47 The report should contain factual information based on all available medical information and results of investigations, the assessor’s own history-taking and clinical examination. The other reports or investigations that are relied upon in arriving at an opinion should be appropriately referenced in the assessor’s report.
1.48 As the Guidelines are to be used to assess permanent impairment, the report of the evaluation should provide a rationale consistent with the methodology and content of the Guidelines. It should include a comparison of the key findings of the evaluation with the impairment criteria in the Guidelines. If the evaluation was conducted in the absence of any pertinent data or information, the assessor should indicate how the impairment rating was determined with limited data.”
In most MACs involving psychological injury, the material provided under the heading “Social activities/ADL” is detailed because it forms the basis of the PIRS assessment. It is important that information be provided in detail so that the parties and any Appeal Panel can understand the particular aspects of the history on which the Medical Assessor relied and why the relevant assessments have been made.
In this case, the Medical Assessor merely wrote:
“Social activities/ADL: reduction in ADLs. Reduction in self care. Shops in the local area. Can travel independently. Maintains good relationship with son. Relationship with husband is strained and they sleep in separate rooms. They are not longer intimate. She sees her grandson approximately once a month. Every year in January they travel 90 minutes to Seal Rocks for a holiday. She has friends who come and visit. She is unable to concentrate to read but enjoys Home and Away and the Voice on television.”
When setting out his findings on examination the Medical Assessor said:
“Appeared his [sic] stated age. 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.”
The MAC is poorly proofread and internally inconsistent. The Medical Assessor provided two separate sections headed “Summary” and two sections headed “Evaluation of Permanent Impairment” at sections 7 to 8 and 10 to 11. In the first Summary, the Medical Assessor diagnosed major depressive disorder and said there was no significant inconsistency of presentation. In the first Evaluation he said that the condition had not reached maximum medical improvement and that “6 -12 months of appropriate treatment” was required. In the second Summary, the Medical Assessor made the same diagnoses and said “there is some inconsistency between her subjective account and the social media investigation report.” In that Evaluation, the Medical Assessor said that Ms Whiteley’s condition had reached maximum medical improvement.
In providing the reasons for his assessment on each occasion the Medical Assessor said only:
“In making that assessment I have taken account of the following matters:- History, examination and collateral information”
The Medical Assessor directed a reader of the MAC to “see table” for an explanation of his calculations. He said:
“My brief comments regarding the other medical opinions and findings submitted by the parties and, where applicable, the reasons why my opinion differs
Dr Allan 5/12/22 WPI 22%
Dr Chowdry 23/2/23 WPI 7% (including 1% for pre-existing)Areas of disagreement:
Self care I prefer Dr Chowdry. There is mild impairment. She is able to look after herself independently. She can prepare some meals
Social and recreational activities I prefer Dr Chowdry. She maintains some relationships with family and friends. She is able to go on annual holiday with family. Mild impairment.
Adaptation. I prefer Dr Allan. She is totally impaired and unable to work currently.
I no [sic] not agree that a pre-existing impairment deduction is warranted as her condition was fully recovered with no functional impairment.”
The role of the Medical Assessor was not to choose between the opinions of the other doctors whose reports appear in the file but to form his own opinion, explaining the reasons for his assessment. In State of New South Wales (NSW Department of Education) v Kaur[3] Campbell J said:
“In Wingfoot Australia Partners Pty Ltd v Kocak [2013] HCA 43; 252 CLR 480, the High Court of Australia dealt with the nature of the jurisdiction exercised by a medical panel under cognate Victorian legislation. The legislation is not entirely the same but it is broadly similar in purpose. Allowing for some differences, the High Court said at page 498 [47]:
‘The material supplied to a medical panel may include the opinions of other medical practitioners, and submissions to the Medical Panel may seek to persuade the Medical Panel to adopt reasoning or conclusions expressed in those opinions. The Medical Panel may choose in a particular case to place weight on the medical opinion supplied to it in forming and giving its own opinion. It goes too far, however, to conceive of the functions of the panel as being either to decide a dispute or to make up its mind by reference to completing contentions or competing medical opinions. The function of a medical panel is neither arbitral or adjudicative: It is neither to choose between competing arguments nor to opine on the correctness of other opinions on that medical question. The function is in every case to perform and to give its own opinion on the medical question referred to it by applying its own medical experience and its own medical expertise.’
Not all of this, as I have said, is apposite in the context of the New South Wales legislation. In particular it is obvious that approved medical specialists are required to decide disputes referred to them by the process of medical assessment. Even so, it is not necessary that approved medical specialists should sit as decision makers choosing between the competing medical opinions put forward by the parties. Essentially, the function is the same as that described by the High Court in Wingfoot Australia. That is to say, their function is in every case to form and give his or her own opinion on the medical question referred by applying his or her own medical experience and his or her own medical expertise. It is sufficient, as their Honours pointed out at [55], that:
‘The statement of reasons… explain the actual path of reasoning in sufficient detail to enable the Court to see whether the opinion does or does not involve any error of law.’”
[3] [2016] NSWSC 346.
The MAC does not explain the Medical Assessor’s actual path of reasoning.
In the PIRS Rating form the Medical Assessor said that Ms Whiteley should be assessed in class 2 for self care and personal hygiene because:
“Reduction in self care
Mild impairment. She is able to prepare some meals.”
He said that she should be assessed class 2 for social and recreational activities because of
“Reduced social functioning. Has withdrawn from friends.
Continues to maintain some relationships with some family and some friends.”
The Medical Assessor omitted most of the Deduction section of the usual MAC template but said:
“I no not agree that a pre-existing impairment deduction is warranted as her condition was fully recovered with no functional impairment.” [sic]
The certificate page was incomplete.
In Parker v Select Civil Pty Limited,[4] Harrison AsJ said:
“In Ferguson v State of New South Wales [2017] NSWSC 887 at [23], Campbell J cited with approval NSW Police Force v Daniel Wark [2012] NSWWCCMA 36 (‘Wark’), where it is stated at [33]:
‘…the pre-eminence of the clinical observations cannot be understated. The judgment as to the significance or otherwise of the matters raised in the consultation is very much a matter for assessment by the clinician with the responsibility of conducting his/her enquiries with the applicant face to face. …’
In relation to Classes of PIRS there has to be more than a difference of opinion on a subject about which reasonable minds may differ to establish error in the statutory sense. (Ferguson [24]).”
[4] [2018] NSWSC140 at [65]-[66].
The lack of reasons in the MAC required a re-assessment and necessitated Dr Andrews taking a detailed history of Ms Whiteley’s activities of daily living to properly assess her under the PIRS.
The evidence in the file and Dr Andrews’ examination confirms that Ms Whiteley has reached maximum medical improvement.
Because the appeal is limited to two of the tables in the PIRS, and therefore to Ms Whiteley’s functioning on the day of any relevant assessment,[5] we have not summarised the extensive medical evidence in the file.
[5] Guidelines paragraph 1.6.
Self care and personal hygiene
Ms Whitely relied on the statement prepared by MH Management’s Investigator with respect to her injury. With respect to the impact of the injury, she provided a short statement adopting the history provided to Dr Allan for his report dated 5 December 2022. Dr Allan also did not set out a detailed history of Ms Whiteley’s activities of daily living. He assessed Ms Whiteley in class 3 and said:
“She reports that she has ’let the house go.’ She will occasionally do some cooking and some cleaning tasks but needs encouragement and support during this. She is not spontaneous with her self care. She does not wash daily. She neglects her personal appearance. She scores 3.”
That assessment does not, in our view, support assessment in class 3. The table assesses the extent to which a worker can live independently and maintain personal hygiene. The examples for class 2 (mild impairment) and class 3 (moderate impairment) are:
“Mild impairment: Able to live independently; looks after self adequately, although may look unkempt occasionally; sometimes misses a meal or relies on take-away food.
Moderate impairment: Can't live independently without regular support. Needs prompting to shower daily and wear clean clothes. Does not prepare own meals, frequently misses meals. Family member or community nurse visits (or should visit)
2-3 times per week to ensure minimum level of hygiene and nutrition.”Dr Chowdary saw Ms Whiteley at the request of MH Management and said in a report dated 23 February 2023:
“She said that cooking was something that she used to enjoy, but it is more of a task and she may cook one meal a day. …
She said that she used to be house proud and keeps the house very tidy but has not been paying attention to it. It has been neglected though she still does a little bit of cleaning and tidying up and tries to help with washing of clothes.”
Dr Chowdary assessed Ms Whiteley in class 2 because:
“She is independent in terms of looking after herself although she may look unkempt at times but generally appears to be maintaining herself care and personal hygiene.”
The history that Dr Andrews took supports assessment in class 2 for self -care and personal hygiene. Though her ability to care for herself and her home is diminished by her injury, Ms Whiteley would be capable of living independently.
Social and recreational activities
Dr Allan assessed Ms Whiteley in class 3 because:
“She does not exercise. Friends may visit her home or she and her husband will go and visit close friends. This is a rare occurrence. She does not enjoy social activity and remains actively withdrawn. She does not engage. She scores a 3.”
Dr Chowdary elided examples from a number of different PIRS tables when he said:
“She does go out to visit her friends and her Mum and Dad who live locally though generally she can be avoidant even though she would go to the yearly trip to Seal Rocks but tends to stay in her caravan park and not go out. She drives locally without support persons and familiar areas like shops, visiting a neighbour etcetera.”
The MAC suggests the Medical Assessor may also have been confused about what the social and recreational activities table measures. He focussed on the maintenance of relationships with family and friends and the ability to go on an annual holiday to the same location every year. Those factors are more relevant to the tables of social functioning and travel. The social and recreational activities table measures the extent of a worker’ participation in activities and her interaction with others.[6]
[6] Ballas v Department of Education (State of New South Wales) [2020] NSWCA 86 at [100].
The history Dr Andrews obtained shows that Ms Whiteley rarely goes out to social events and sees her friends when they visit her. Though she does still go on an annual camping holiday with her husband, she has been going to the same place for 25 years. Her social interaction with others while there is limited and is similar to that while she is at home. We consider that Ms Whiteley’s impairment is moderate.
Conclusion
The appropriate assessments are therefore:
• Self care and personal hygiene – class 2;
• Social and recreational activities – class 3;
• Travel – class 2;
• Social functioning – class 2;
• Concentration, persistence & pace – class 3, and
• Employability – class 5.
Arranging the classes in ascending order (2, 2, 2, 3, 3, 5), the aggregate is 17 and the median is 2.5, rounded to 3. Under Table 11.7, that converts to 19% WPI. MH Management did not appeal the Medical Assessor’s failure to make a deduction under s 323 so no deduction is required.
For these reasons, we have determined that the MAC issued on 5 October 2023 should be revoked, and a new MAC should be issued. The new certificate is attached to this statement of reasons.
Issued by:
Andrew Shaw
Dispute Support Officer
WORKERS COMPENSATION DIVISION
APPEAL PANEL
MEDICAL ASSESSMENT CERTIFICATE
Injuries received after 1 January 2002
Matter number: | W4080/23 |
Applicant: | Amanda Whiteley |
Respondent: | MH Management (New South Wales) Pty Ltd |
This Certificate is issued pursuant to s 328(5) of the Workplace Injury Management and Workers Compensation Act1998.
The Appeal Panel revokes the Medical Assessment Certificate of Medical Assessor 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 WorkCover Guides | Chapter, page, paragraph, figure and table numbers in AMA 5 Guides | % WPI | Proportion of permanent impairment due to pre-existing injury, abnormality or condition | Sub-total/s % WPI (after any deductions in column 6) |
| Psychological injuries | 21.11.17 | Chapter 11 | N/A | 19 | 0 | 19 |
| Total % WPI (the Combined Table values of all sub-totals) | 19% | |||||
PERSONAL INJURY COMMISSION
APPEAL AGAINST MEDICAL ASSESSMENT REPORT OF THE EXAMINATION BY MEDICAL ASSESSOR
MEMBER OF THE APPEAL PANEL
MatterNumber: | M1-W4080/23 |
Appellant: | Amanda Whitely |
Respondent: | MH Management (NSW) Pty Ltd |
ExaminationConductedBy: | Dr Douglas Andrews |
DateofExamination: | 7 February 2024 |
The workers medical history, where it differs from previous records
Ms Whitely lives with her husband, Michael, and their 26-year-old son, Aden. Michael works full-time at Tomago Aluminium, and Aden is a customer service manager with BCF.
Ms Whitely consulted general practitioner Dr Megan Lever and a psychologist, Emily (she could not recall the last name). She intermittently has access to a psychiatrist through the public health system but is not receiving routine care.
She worked as a night supervisor at the Oaks Lakes Resort from September 2015 until November 2017, when she left because of her mental health decline due to her workplace difficulties. She was given a return-to-work position at a sister resort at Salamander Bay, where she worked three days a week. This lasted only a couple of months before she felt unable to continue.
She later volunteered at Oakvale Wildlife Park cleaning animal enclosures but found the work too physically demanding. For the last couple of years, she has not worked in any capacity, paid or voluntary.
She has long-standing mental health challenges. A general practice record written by Dr Tony Cosby on 12 December 2003 refers to “Years of depression, probably since the birth of her younger son [Aden].” There are regular clinical notes related to ongoing mental health care by general practitioners right up until the time she starts work at Oaks Lakes Resort. During these years, she was on several different medications.
Her current medication regimen includes lurasidone 40 mg daily, lithium carbonate 500 mg BD, venlafaxine 150 mg mane and quetiapine 25 mg at night. This is a complex mix of medications, including antipsychotics, mood stabilisers and antidepressants. Such combinations can be used in severe, difficult-to-treat mood disorders, including major
depressive disorder and bipolar disorder. Ms Whitely disputes a bipolar diagnosis, although this diagnosis was accepted by her treating psychiatrist, Dr Stewart Saker. On questioning Ms Whitely today, I was unable to elicit a convincing history of hypomania, mania, or psychosis.
Ms Whitely has hypertension and asthma; she takes candesartan and an aerosol medication. She is smoking 30 cigarettes a day (an increase from before her workplace injury) and does not drink alcohol. She has a varied diet, often relying on takeaway food and consuming regular Coca-Cola. Her weight is 91 kg; at 173 cm, her BMI is 30.4, in the obese range. I note that her weight was 91 kg in 2014.
The worker has appealed the MA’s PIRS ratings for self-care & personal hygiene, and social & recreational activities.
Additional history since the original Medical Assessment Certificate was performed
Ms Whitely’s condition has not changed significantly since her assessment with the MA on 5 October 2023. He provided conflicting answers regarding whether she had reached maximum medical improvement (paragraphs 8b and 11h). He did not address whether Ms Whitely had a pre-existing impairment. Her treatment remains much as it was.
Symptoms:
Ms Whitely said she was “always down” without diurnal variation. She is fatigued and finds it difficult to be motivated. She looks forward to and can experience some pleasure in visiting with her two-year-old grandson.
She is anxious, especially when away from home or in crowded places. She has intrusive thoughts about events in the workplace and worries about her family and her relationship with her husband. She has no libido and sleeps in a separate room.
She is often irritable and prone to express anger with her husband or son. She has subjective difficulties with concentration, attention, and memory.
She often has thoughts of suicide and, on one occasion, took herself to the hospital seeking support.
She goes to bed at 9:30 PM but has initial and middle insomnia. She has occasional distressing dreams. She rises at about 7 AM.
Diagnosis:
Ms Whitely meets the DSM-5 diagnostic criteria for a major depressive episode, with melancholic features and anxious distress.
Ms Whitely has long-standing, stable and entrenched mental health problems. She has received extensive and assertive treatment. Her condition will not change significantly over the next twelve months, with or without further medical treatment. She has reached maximum medical improvement.”
Activities of daily living:
After rising, Ms Whitely feeds her dog and lets it out in the yard. She spends some time sitting outside, drinking Coca-Cola and smoking cigarettes. During the day, she may “potter” doing bits of housework, but she maintains a lower standard than before her injury. She likes sitting in her swimming pool.
Her husband and son share meal preparation with her, but they often have takeaways. She often skips meals, sometimes twice daily, but has maintained her weight.
Without prompting, she showers every second day and washes her hair weekly. She occasionally has a hairdresser visit her home.
Before becoming unwell, she had a circle of about ten friends. She enjoyed going to restaurants and cafés. She often went out to dinner with her husband or to a local bowling club to watch a band. She enjoyed camping, including annual trips to Seal Rocks.
She now rarely visits a café or club. She did so for a family event at a local club in January 2024 to celebrate her father-in-law’s birthday. She doesn’t go out with her girlfriends, but they still exchange home visits. She has continued to visit Seal Rocks for camping. She enjoys sitting on the beach while her husband finishes. They have been attending Seal Rocks for 25 years and know many other campers. She said hello to them on a recent trip, but they didn’t socialise.
She is independent in her local travel, visiting calls or her parents. On a longer trip, such as that to Seal Rocks, her husband does the driving. Such trips are infrequent.
There is some strain in her relationship with her husband, but they remain caring and loving toward each other. She is close to her sons, grandchild, parents, two sisters and three girlfriends. She has not lost any friends but has little contact with those who were not closest to her.
She watches television series but struggles to remember the characters and plots. She enjoys gardening and is interested in succulents. She has no other hobbies or projects.
Findings on clinical examination
I assessed Ms Whitely by video link while she was at her solicitor’s office. We resolved some sound difficulties, and the connection was adequate for a comprehensive assessment lasting 60 minutes.
She presented as a middle-aged woman, casually attired with her hair pulled back. She was cooperative during the interview, being open and forthcoming.
Her mood was flat, and she was anxious about the interview. Her affect was restricted, consistent with her stated mood and congruent with the interview content. She maintained her composure throughout.
There was no evidence of any disorder of thought-form perception. Her responses were slow and measured, reflecting possible mild psychomotor slowing. She was imprecise regarding some of her history and event sequences, consistent with attentional and memory difficulties.
She acknowledged ongoing thoughts of suicide without plans or intent.
Results of any additional investigations since the original Medical Assessment Certificate
Self-care & personal hygiene:
Ms Whitely contributes to housework, including cleaning and meal preparation, but at a lower standard than before her workplace injury. She has a poor-quality diet, often takeaway food, and consumes excessive Coca-Cola. She smokes 30 cigarettes daily, an increase from before her injury. She showers only every second day and washes her weekly, but without prompting. She is capable of independent living. – Class 2.
Social & recreational activities:
Ms Whitely has curtailed her social and recreational activities. She rarely goes to a restaurant or café – on the one occasion she has recently, this was with a family group. She has continued annual camping with her husband at Seal Rocks but tends to keep to herself, limiting social interaction to saying hello. She exchanges home visits with her closest girlfriends, but they no longer go out together. She is not actively involved when out, tending to remain quiet and withdrawn. – Class 3.
The other class ratings determined by the MA were not appealed. They were:
• Travel – class 2
• Social functioning – class 2
• Concentration, persistence & pace – class 3
• Employability – class 5
With the combined ratings (classes 2, 3, 2, 2, 3, and 5), the aggregate is 17, and the median is 3. This equates to a 19% WPI.
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6
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