Williams v State of NSW (Northern NSW Local Health District)

DETERMINATION OF APPEAL PANEL
CITATION:	Williams v State of NSW (Northern NSW Local Health District) [2023] NSWPICMP 119
APPELLANT:	Cherie Williams
RESPONDENT:	State of New South Wales (Northern NSW Local Health District)
Appeal Panel
MEMBER:	Deborah Moore
MEDICAL ASSESSOR:	Douglas Andrews
MEDICAL ASSESSOR:	Michael Hong
DATE OF DECISION:	29 March 2023
CATCHWORDS:	wORKERS cOMPENSATION - The appellant submitted that the Medical Assessor (MA) erred in his assessment with respect to five of the psychiatric impairment rating scale (PIRS) categories; Panel agreed the MA erred in two of the five categories; Held – Medical Assessment Certificate revoked.

BACKGROUND TO THE APPLICATION TO APPEAL

On 9 December 2022 Cherie Williams (the appellant) lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by Dr Yu-Tang Shen, a Medical Assessor, who issued a Medical Assessment Certificate (MAC) on
11 November 2022.
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).

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 it was not necessary for the worker to undergo a further medical examination because although one was requested, we consider that we have sufficient evidence before us to enable us to determine this appeal for reasons that will become apparent in due course.

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.

SUBMISSIONS

Both parties made written submissions. They are not repeated in full, but have been considered by the Appeal Panel.
In summary, the appellant submits that the Medical Assessor erred with respect to five of the categories in the psychiatric impairment rating scale (PIRS) namely Self-care and personal and hygiene; Travel; Social Functioning; Concentration, persistence and pace (CPP) and Employability.
In reply, the respondent submits that no errors were made.

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 appellant was referred to the Medical Assessor for assessment of whole person impairment (WPI) in respect of a primary psychological injury on a deemed date of injury of
7 February 2019.
The Medical Assessor commenced by setting out in great detail all the material he had before him.
He then set out the history he obtained as follows:
“She said that on 18 October 2018, she was doing a medication round with another nursing staff, and security guard, and on returning to the nursing office, a patient pushed her colleagues and started to try to strangle her with her hands, yelling that she would ‘fucking kill’ her. The staff then locked themselves on the unit and didn’t help her. She said there has been other incidents in other work places, including at Ballina hospital, including one dying patient who tried to stab her with morphine and being assaulted by people who were disoriented at night, who didn’t have the right care plan or medications in place.
She said she left working with Northern NSW LHD straight after the contract ended in 2018.
I put to her that she left after being accused of spreading rumours. She initially dismissed this as being an instrumental part of her leaving, then said it was an ‘unfair proposal’ to her, and had attacked her on the phone. I asked if that was when she stopped working for them. She said it was a week after that, and she had taken a break from them, but she said in the interval she was ‘kicked off’ the system. I put to her that she had verbally resigned on the phone call, which she said was ‘incorrect’.
She said she had difficulties with sleep, and recurring voice that will kill her, and that they started immediately after the assault in October 2018. She then said things worsened when she realised she had no work option and no ability to support herself in February 2019.
She then developed symptoms of ‘very depressed’, spending a couple of weeks in bed run down and burnt out.
She has had treatment including seeing her GPs, seeing EAP a couple of times, seeing her psychologist, and saw a psychiatrist, and treated with Citalopram and increased to 30mg by her psychiatrist, and started on diazepam. She was also prescribed quetiapine for when she had committed the crime, but she found it too sedating.
I asked if she thinks she has improved with treatment. She said that she is up and down, with periods of improvement then regression. She attributed it to the nature of the mental health issue that she has. Overall, she thinks she has improved.
I asked about her personal life stressors and how much that has impacted on her mental health, and she said that she found it difficult losing her mother, which had compounded what has been happening to her.”
After setting out details of Ms Williams’ treatment, the Medical Assessor noted “present symptoms” as follows:
“She said she has depressed mood most of the time, with minimal improvement with positive experiences, and heightened anxiety. She has ongoing insomnia, with initial and middle insomnia, and reduced by 3 hours. She has poor appetite with little pleasure from eating food, and forces herself to eat, but her weight remains stable. She said she has poor concentration, and she cannot read a newspaper, and reading only 2-6 minutes limit, including those articles on abstinence, only 1000-2000 words article. She said that she struggles with the “get up and go” and everything is an effort. She has no enjoyment in life, apart from with the cat and she feels detached from everybody but she has ongoing anger. She has ongoing feelings of worthlessness. She has lots of thoughts of death and dying, with plans and sorting her will. She has not self-harmed for a long time, and she last self-harmed in 2019.
She said that the most distressing trauma was the verbal abuse, then the lack of support by management.”
The Medical Assessor then turned to consider “Details of any previous or subsequent accidents, injuries or conditions” adding:
“Prior to the subject injury, she denied any significant anxiety. She acknowledged having social anxiety, but without anxious avoidance.
Prior to the subject injury, she was diagnosed with depression by her GP around 2009. This was in the context of various stressors including family conflict with her mother, her son was “becoming pubescent, rebellious and violent” with her, she was in-between jobs, and finished TAFE which she felt was toxic, and she was overwhelmed. She had pervasive depressed mood lasting for 12 months, and she increased sleeping and reduced appetite with thoughts of self-harming. She had no self-harming at the time. She was treated with psychological therapy and medications, citalopram 20mg. She denied being depressed before 2009.
She said she ceased antidepressants as she was feeling good, around 2014.
She then became depressed after 18 months to 2 years, when she became overwhelmed and depressed again, around 2014-2015. She said that it was due to the progression of her mother’s cancer diagnosis, on top of other financial and family stressors. She then restarted her antidepressant soon after, and she recovered within 6 months, around 2015 or 2016.
Prior to the work injury, she denied any psychosis, hypo/manic episodes, dissociation, or eating disorder.
She has had previous treatment including psychological therapy and citalopram.
Prior to the subject injury, she would drink alcohol on social occasions, and denied any substance use. She started to escalate with her drinking to 6 standard drinks after work, from 2018 which she said was part of the culture, and it fluctuated a lot, going up significantly to having black outs. She has been drinking only 3 days a week, 3 standard drinks each, with a compulsive urge to drink. She has considered a detox treatment, and used diazepam to reduce use, and using self-directed detoxifying herbs and using reading articles about abstinence, which she finds helpful listening and reading other people’s experiences.
She had no forensic issues prior to the work injury. She said after the subject injury, in July 2020, she was in a relationship with a former colleague, and unhappy with the people he was inviting to their house and she smashed two cars with a cricket bat and breached an AVO for continuing to contact the person and badly behaved. This was in the context of alcohol use…
She has studied Cert IV in nursing and training and assessment, and Cert III in Millinery and using a computer. She then completed her Bachelor of Nursing, which she completed in 2012. Then she did a graduate certificate in Emergency Nursing. She had no difficulties with completing these…
She has worked in Health since 2003, initially as an enrolled Nurse. Prior to the work injury, she denied any significant work performance issues, disciplinary matters or conflicts…
She has been working as a registered nurse since 2012.”
The Medical Assessor then turned to consider the impact of Ms Williams’ injury on her social activities and activities of daily living (ADL’s) and said:
“She is living in Wollenbar, with her daughter. She has two children, including her son 27 years old and daughter 23 years old. She has 2 younger siblings. She said she doesn’t really have any friends. She looks after her mother’s pets and her daughter’s dog.
She says she is bad with self-care, even with showering only once a week, and she mainly eats cereals and tea and always skips meals and her daughter is not looking after her.
She previously enjoyed traveling, shopping and dining with her family, and now rarely leaves the house, unless necessary. She doesn’t even like gardening anymore, compared when she used to enjoy that. She had a BBQ in late August for her son’s birthday and only 2 of his friends attended and she said she spent a little time with them, and has not been out for 2 years, except to her daughter’s 20^th, and her mother’s funeral.
She doesn’t travel around much anymore, but she can do shopping locally if she needs to, though she prefers her daughter to do the shopping. She went to the local shops today to buy tea.
She has lost all her friends since the work injury, and she felt that she was well-liked in the community beforehand. I asked how many friends she had, and she said she had a couple of close friends and she is no longer in touch with her, but she re-connected with her oldest friend. She has had multiple issues with her children and her family after the injury, and her children find it difficult to see her like that and her drinking, so there has been some strain. She is no longer talking to her siblings.
She said her concentration has not been good.
She is not working at the moment, and she last worked as a registered nurse in July 2021 on one shift. She has been trying to return to work since then, and did a day at a bakery a few months ago. She is currently on the disability support pension. After the work injury, she has had brief periods of work, and she said she was pretending things were ok, but she would be assaulted by patients and staff after that. She said she was working over a period from late 2019 to 2020, then I asked her why she said she last worked in 2021, and she acknowledged she last worked there, but felt there was no support at that aged care home and she was averaging about 3 shifts.”
Findings on examination were reported as follows:
“She was groomed and engaged well in the interview and was forthcoming with her responses.
Her mood was low and anxious, with a congruent restricted and dysthymic affect.
She was articulate, with minimal reduction of prosody.
She had suicidal thoughts and felt hopeless, and vigilance.
She denied any paranoia.
She appeared alert and sustained concentration for the duration of the interview.
She complained of attentional difficulties.”
The Medical Assessor then set out “details and dates of special investigations” and said:
“She underwent clinician-administered testing. Her depression rating (MADRS) was in the severe range (35). Her PTSD rating (CAPS-5) was supportive of PTSD diagnosis, with a severity score of 40. Her performance validity test of psychiatric symptoms (M-FAST) was credible. She undertook a cognitive test (RBANS subtests) and demonstrated credible performance on an embedded performance validity test (Effort Index), and demonstrated average verbal learning, with high average recall, and average prompted recall, and high average attentional capacity.”
He then summarised the injuries and diagnoses as follows:
“Her presentation is consistent with:
·    Post-Traumatic Stress Disorder
·    Persistent Depressive Disorder
·    Alcohol use disorder
·    consistency of presentation
Her overall presentation of symptoms was consistent internally, consistent with the available medical records, contradicted statements by the employer, and she demonstrated credible performance on a couple of performance validity tests undertaken. There is a plausible mechanism of injury, with a plausible progression of symptoms. There is a disproportionate degree of psychiatric functional impairment she described to me, and discrepant with her function she has described elsewhere in the history, such as having a romantic relationship, and also with her description to
Dr Dayalan in July 2022. There is underlying motivation for amplification of her functional impairment status.”
The Medical Assessor assessed 7% WPI.
He explained his reasons principally by reference to the extensive medical records he had outlined at the start of his determination.
He added:
“Assessment on 31 October 2022
She says she is bad with self-care, even with showering only once a week, and she mainly eats cereals and tea and always skips meals and her daughter is not looking after her.
She previously enjoyed traveling, shopping and dining with her family, and now rarely leaves the house, unless necessary. She doesn’t even like gardening anymore, compared when she used to enjoy that. She had a BBQ in late August for her son’s birthday and only 2 of his friends attended and she said she spent a little time with them, and has not been out for 2 years, except to her daughter’s 20^th, and her mother’s funeral.
She doesn’t travel around much anymore, but she can do shopping locally if she needs to, though she prefers her daughter to do the shopping. She went to the local shops today to buy tea.
She has lost all her friends since the work injury, and she felt that she was well-liked in the community beforehand. I asked how many friends she had, and she said she had a couple of close friends and she is no longer in touch with her, but she re-connected with her oldest friend. She has had multiple issues with her children and her family after the injury, and her children find it difficult to see her like that and her drinking, so there has been some strain. She is no longer talking to her siblings.
She said her concentration has not been good.
She is not working at the moment, and she last worked as a registered nurse in July 2021 on one shift. She has been trying to return to work since then, and did a day at a bakery a few months ago. She is currently on the disability support pension. After the work injury, she has had brief periods of work, and she said she was pretending things were ok, but she would be assaulted by patients and staff after that. She said she was working over a period from late 2019 to 2020, then I asked her why she said she last worked in 2021, and she acknowledged she last worked there, but felt there was no support at that aged care home and she was averaging about 3 shifts.”
He then turned to consider the other medical reports and said:
“I agree with Dr Satish Dayalan’s classification of her WPI, and disagree with
Dr Chow’s assessment. I disagree with Dr Chow’s assertion she is a Class 3 for self-care, as she is able to independently self-care, and was not reliant on others. I disagree with Class 3 for social functioning, as she has maintained a relationship with her daughter who lives with her, hosted her son’s birthday party, and sees a friend on a regular basis and her sister. I disagree with Class 3 for concentration, as her concentration was reasonably good on testing, and she has been able to complete two basic refresher courses. I disagree with her employability being Class 5, as she has been able to return to work for brief periods of time, over protracted period, even though her performance is reduced in quality.”
Dealing firstly with the category of Self-care and personal hygiene, the appellant makes the following submissions:
(a)     the Medical Assessor does not, either in the PIRS specifically refer to the requirements of the Guidelines, or the differences in classes which are relevantly contained in the Tables;
(b)     the Medical Assessor’s reasoning process for each class for each of the scales is inadequate;
(c)     the Medical Assessor has not set out the relevant descriptors of the competing relevant classes for each category under the PIRS, nor does he provide any adequate reasons as to how he arrives at the determination he does;
(d)     it is clear from the facts as found by the Medical Assessor that she is not able to look after herself adequately, and that she requires external support from her daughter in order to do so, namely, that she showers once a week, and always misses meals when her daughter is not looking after her. These facts are at least, if not preponderately, more consistent with Class 3, and
(e)     Dr Chow in his report dated 5 January 2022 stated:
"Ms Williams is neglecting her hygiene and appearance. She is skipping showering and meals. She showers every two or three days. She can do a little bit of house chores but is not engaging in grocery shopping."

In assessing a Class 2 in this category, the Medical Assessor said:
“She says she is bad with self-care, even with showering only once a week, and she mainly eats cereals and tea and always skips meals and her daughter is not looking after her.”
The descriptor for a Class 2 in respect of Self-Care and personal hygiene reads:
“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.”
For a Class 3 it reads:
“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.”
On one view of the evidence Ms Williams’ level of self-care is clearly poor, and some features of her presentation to the Medical Assessor as regards this PIRS category may be consistent with a Class 3.
However, having said that, the difference between a Class 2 and 3 is whether the person can live independently without regular support.
In our view, Ms Williams can live independently, albeit with some difficulty. She said, for example, that “she can do shopping locally if she needs to, though she prefers her daughter to do the shopping. She went to the local shops today to buy tea”.
It is perhaps timely at this point to set out the task of an Appeal panel as stated in Ferguson v Stateof New South Wales [2017] NSWSC 887 where Campbell J said:
“[23] By reference to NSW Police Force v Daniel Wark [2012] NSWWCCMA 36, the Appeal Panel directed itself that in questions of classification under the PIRS: ‘... the pre-eminence of the clinical observations cannot be underrated. 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’ (our emphasis).
[24] The Appeal Panel accepted that intervention was only justified: if the categorisation was glaringly improbable; if it could be demonstrated that the AMS was unaware of significant factual matters; if a clear misunderstanding could be demonstrated; or if an unsupportable reasoning process could be made out. I understood that all of these matters were regarded by the Appeal Panel as interpretations of the statutory grounds of applying incorrect criteria or demonstrable error. One takes from this that the Appeal Panel understood that more than a mere difference of opinion on a subject about which reasonable minds may differ is required to establish error in the statutory sense.
[25] 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’…
[37] The descriptors, or examples, describing each class of impairment in the various categories are ‘examples only’…”
Chapter 1.6 of the Guidelines provides: “Assessing permanent impairment involves clinical assessment of the claimant as they present on the day of assessment…” (our emphasis)
We are required to determine if the Medical Assessor made an error, regardless of other “reasonable minds” that may differ.
In this case, the Medical Assessor clearly noted that Ms Williams was “able to independently self-care, and was not reliant on others”.
For these reasons, we do not consider that the Medical Assessor erred in his assessment in this category. His assessment was open to him on all of the evidence.
Turning next to the category of Travel, the appellant submits that a Class 3 should be allocated. This is mainly on the basis of the history recorded by Dr Chow that “Ms Williams hardly goes out. She can drive to her doctors by herself".
The appellant also added: “she has experienced agoraphobia, and rarely leaves the house, which presents greater consistency with Class 3”.
The descriptor for a Class 2 reads: “Mild impairment: Can travel without support person, but only in a familiar area such as local shops, visiting a neighbour”.
For a Class 3 it reads: “Moderate impairment: Cannot travel away from own residence without support person. Problems may be due to excessive anxiety or cognitive impairment”.
In assessing a Class 2, the Medical Assessor said:
“She doesn’t travel around much anymore, but she can do shopping locally if she needs to, though she prefers her daughter to do the shopping. She went to the local shops today to buy tea.”
Overall, we do not agree that Ms Williams’ ability to travel is consistent with a Class 3. She can go out independently without a support person. As Dr Chow noted, “she can drive to her doctors by herself".
For these reasons we do not consider that the Medical Assessor erred in his assessment with respect to this category.
Turning now to the category of Social Functioning, the appellant submits as follows:
(a) since the injury, her previously established relationships with friends have become severely strained, and she has experienced multiple issues with her children and family. These facts are more consistent with Class 3, and
(b) Dr Chow in his report dated 5 January 2022 stated:
"Ms Williams is not seeing friends and has lost friendships. Her relationship with her family has deteriorated. She has asked her son to move out due to the deteriorated relationship."
The Medical Assessor assessed a Class 2 and said:
“She has lost all her friends since the work injury, and she felt that she was well-liked in the community beforehand. I asked how many friends she had, and she said she had a couple of close friends and she is no longer in touch with her, but she re-connected with her oldest friend. She has had multiple issues with her children and her family after the injury, and her children find it difficult to see her like that and her drinking, so there has been some strain. She is no longer talking to her siblings. She has been able to have her daughter live with her, and hosted her son’s birthday party a month ago.
However, Dr Dayalan reported she has been meeting a friend monthly, and seeing her sister every few months, and was in a relationship after the subject injury.”
The descriptor for a Class 2 reads:
“Mild impairment: Existing relationships strained. Tension and arguments with partner or close family member, loss of some friendships.”
For a Class 3 it reads:
“Moderate impairment: Previously established relationships severely strained, evidenced by periods of separation or domestic violence. Spouse, relatives or community services looking after children.”
The Medical Assessor noted that “She has lost all her friends (our emphasis) since the work injury…” In other words, on the history he obtained, she has lost more than “some friendships”.
It is also clear that Ms Williams’ relationship with her family is “severely strained” and on the history obtained by Dr Chow, there have been periods of separation when she asked her son to move out.
Whilst a Medical Assessor is not bound by the opinions of other doctors, those opinions do form part of the evidence.
The same must be said of the opinion of Dr Dayalan
It is the Medical Assessor’s own history taking that has formed the basis of this appeal. In other words, on the information obtained by the Medical Assessor himself, on the day of his assessment, he has by definition erred in the rating he ascribed. It would be inconsistent to find a different rating on the information he was given by Ms Williams.
For these reasons we agree with the appellant that on the whole of the evidence, a Class 3 rating in this category is appropriate.
Turning now to the category of CPP, the only submission made by the appellant is that “she has poor concentration, and is unable to read a newspaper, presenting factual consistency with Class 3”.
In assessing a Class 2, the Medical Assessor said:
“She said her concentration has not been good.
She undertook a cognitive test and demonstrated average verbal learning, with high average recall, and average prompted recall, and high average attentional capacity.
Dr Dayalan reported she has been able to complete CPR course and first aid courses, but not longer online courses.”
The Medical Assessor noted that “her concentration has not been good”.
Having said that, he also noted that “her concentration was reasonably good on testing, and she has been able to complete two basic refresher courses”.
It is not clear whether the Medical Assessor was referring to the history obtained by
Dr Dayalan as regards “refresher courses” but in any event, that history also is part of the evidence.
The Medical Assessor noted earlier that on testing:
“She undertook a cognitive test (RBANS subtests) and demonstrated credible performance on an embedded performance validity test (Effort Index), and demonstrated average verbal learning, with high average recall, and average prompted recall, and high average attentional capacity.”
We also point out that the assessment itself is a cognitively demanding task that enables an objective evaluation of an appellant’s impairment in concentrating and persisting with such a task, and the pace at which an appellant can do this.
The Medical Assessor recorded Ms Williams’ “concentration was reasonably good on testing”.
In these circumstances, we do not agree that the evidence supports a Class 3 rating.
Finally, as to the issue of employability, the appellant submits as follows:
(a)      it is clear from the facts as found by the Medical Assessor that she is not working at the moment and she last worked as a registered nurse in July 2021 on one shift. She did a day at a bakery a few months ago. She is currently on the disability support pension;
(b)      furthermore, her brief periods of return to work have failed. Her pace is reduced and attendance is erratic;
(c)      these facts are more consistent with Class 4;
(d)   furthermore, Dr Chow in his report dated 5 January 2022 stated,"She has tried to re-engage back at work but has not been able to sustain employment due to her psychological difficulties", and
(e)    the appellant should be placed in Class 4 for employability.
In assessing a Class 3, the Medical Assessor said:
“She is not working at the moment, and she last worked as a registered nurse in July 2021 on one shift. She has been trying to return to work since then, and did a day at a bakery a few months ago. She is currently on the disability support pension. After the work injury, she has had brief periods of work, and she said she was pretending things were ok, but she would be assaulted by patients and staff after that. She said she was working over a period from late 2019 to 2020, then I asked her why she said she last worked in 2021, and she acknowledged she last worked there, but felt there was no support at that aged care home and she was averaging about 3 shifts.”
The descriptor for a Class 3 reads:
“Moderate impairment: Cannot work at all in same position. Can perform less than 20 hours per week in a different position, which requires less skill or is qualitatively different (eg less stressful).”
For a Class 4 it reads:
“Severe impairment: Cannot work more than one or two days at a time, less than 20 hours per fortnight. Pace is reduced, attendance is erratic.”
Once again, on the history obtained and recorded by the Medical Assessor, the appellant last worked as a registered nurse in July 2021 on one shift. Her attempts to return to work since then have been largely unsuccessful. She is currently on the disability support pension.
In short, there is no evidence that Ms Williams could work “less than 20 hours per week in a different position, which requires less skill or is qualitatively different (eg less stressful)”.
As she told the Medical Assessor, “After the work injury, she has had brief periods of work, and she said she was pretending things were ok, but she would be assaulted by patients and staff after that”.
Clearly that work remained stressful for her, much as Dr Chow noted when he said: “she has not been able to sustain employment due to her psychological difficulties".
In these circumstances we accept that the evidence supports a Class 4 rating.
This then means that the aggregate score is as follows: 2, 3, 2, 3, 2, 4, = 16. Median 3 – 17% WPI.
For these reasons, the Appeal Panel has determined that the MAC issued on
11 November 2022 should be revoked, and a new MAC should be issued. The new certificate is attached to this statement of reasons.

PERSONAL INJURY COMMISSION

APPEAL PANEL

MEDICAL ASSESSMENT CERTIFICATE

Injuries received after 1 January 2002

Matter number:	W2276/22
Applicant:	Cherie Williams
Respondent:	State of New South Wales (Northern NSW Local Health District)

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 Dr Yu-Tang Shen, 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)

1.Psychiatric disorder

7 February 2019

Chapter 11, page 54

Chapter 14, pg 361-365

Total % WPI (the Combined Table values of all sub-totals)

17%

The above assessment is made in accordance with the SIRA NSW Guidelines for the Evaluation of Permanent Impairment for injuries received after 1 January 2002.

[2023] NSWPICMP 119

29 March 2023