Winnacott v Community Housing Ltd
[2023] NSWPICMP 123
•31 March 2023
| DETERMINATION OF APPEAL PANEL | |
| CITATION: | Winnacott v Community Housing Ltd [2023] NSWPICMP 123 |
| APPELLANT: | Susan Winnacott |
| RESPONDENT: | Community Housing Ltd |
| Appeal Panel | |
| MEMBER: | Jane Peacock |
| MEDICAL ASSESSOR: | Nicholas Glozier |
| MEDICAL ASSESSOR: | Douglas Andrews |
| DATE OF DECISION: | 31 March 2023 |
CATCHWORDS: | wORKERS cOMPENSATION - Psychological injury; appellant alleged error in the assessment under one category under the psychiatric impairment rating scale (PIRS) namely, social functioning; the rating in this class was open to the Medical Assessor and the Panel could discern no error; Held – Medical Assessment Certificate confirmed. |
BACKGROUND TO THE APPLICATION TO APPEAL
On 9 November 2022 Ms Susan Winnacott (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 12 October 2022.The appellant relies on the following grounds of appeal under s 327(3) of the Workplace Injury Management and Workers Compensation Act 1998 (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 Guidelines) and the American Medical Association Guides to the Evaluation of Permanent Impairment, 5th ed (AMA 5).
PRELIMINARY REVIEW
The Appeal Panel conducted a preliminary review of the original medical assessment in the absence of the parties and in accordance with the WorkCover Medical Assessment Guidelines 2006.
The appellant did not request a re-examination. As a result of its preliminary review, the Appeal Panel determined that it was not necessary for the worker to undergo a further medical examination because the Appeal Panel could not find error. Absent error, the Appeal Panel has no power to require a re-examination. The Appeal Panel cannot examine the worker to determine whether a ground of appeal has been made out: see New South Wales Police Force v Registrar of the Personal Injury Commission of New South Wales [2013] NSWSC 1792.
EVIDENCE
Documentary evidence
The Appeal Panel has before it all the documents that were sent to the Medical Assessor for the original medical assessment and has taken them into account in making this determination.
Medical Assessment Certificate
The parts of the medical certificate given by the Medical Assessor that are relevant to the appeal are set out, where relevant, in the body of this decision.
SUBMISSIONS
It is noted that the delegate’s decision refers to the respondent employer not having filed a notice of opposition. The Appeal panel notes there is a notice of opposition included with the papers referred to the Appeal Panel.
Both parties made written submissions. They are not repeated in full, but have been considered by the Appeal Panel.
FINDINGS AND REASONS
The procedures on appeal are contained in s 328 of the 1998 Act. The appeal is to be by way of review of the original medical assessment but the review is limited to the grounds of appeal on which the appeal is made.
In Campbelltown City Council v Vegan [2006] NSWCA 284 the Court of Appeal held that the Appeal Panel is obliged to give reasons. Where there are disputes of fact it may be necessary to refer to evidence or other material on which findings are based, but the extent to which this is necessary will vary from case to case. Where more than one conclusion is open, it will be necessary to explain why one conclusion is preferred. On the other hand, the reasons need not be extensive or provide a detailed explanation of the criteria applied by the medical professionals in reaching a professional judgement.
The matter was referred to the Medical Assessor for assessment as follows:
“The following matters have been referred for assessment (s 319 of the 1998 Act):
· Date of injury: 24 June 2021
· Body parts/systems referred: Psychiatric/Psychological Disorder
· Method of assessment: Whole Person Impairment”
The Medical Assessor issued a MAC certifying as follows:
| Body Part or system | Date of Injury | Chapter, page and paragraph number in NSW workers compensation guidelines | Chapter, page, paragraph, figure and table numbers in AMA5 Guides | % WPI | WPI deductions pursuant to S323 for pre-existing injury, condition or abnormality (expressed as a fraction) | Sub-total/s % WPI (after any deductions in column 6) |
| 1. Psychiatric Injury | 24 January 2020 | Chapter 14, Page 361 | 13% | 0 | 13% | |
| 2. | ||||||
| 3. | ||||||
| 4. | ||||||
| 5. | ||||||
| 6. | ||||||
| Total % WPI (the Combined Table values of all sub-totals) | 13% | |||||
The assessment was based on his assessment under the permanent impairment rating scale (PIRS) as required by the Guides as follows:
Table 11.8: PIRS Rating Form
| Name | Susan Winnacott | Claim reference number (if known) | W4239/22 |
| DOB | xxxx, 51 years old | Age at time of injury | 49 years old |
| Date of Injury | 24 June 2021 | Occupation at time of injury | Tenancy officer |
| Date of Assessment | 19 September 2022 | Marital Status before injury | Divorced |
| Psychiatric diagnoses | 1.Major Depressive Disorder | 2. Post-Traumatic Stress Disorder | |||||||||
| 3. | 4. | ||||||||||
| Psychiatric treatment | Fluvoxamine, quetiapine | Psychological therapy | |||||||||
| Is impairment permanent? | Yes | ||||||||||
| PIRS Category | Class | Reason for Decision | |||||||||
| Self Care and personal hygiene | 2 | She has been able to look after herself, including showering daily without prompting, except on weekends if she has nothing on. She has been able to buy frozen meals, and cooking for herself, whereas she would cook for herself more and would enjoy that. She cleans her house and keeps it clean. | |||||||||
| Her appetite has been reduced, and she feels she has to force herself to eat and has two meals a day. She has not regained the weight she has lost. | |||||||||||
| Social and recreational activities | 3 | She has been able to catch up with friends, who picked her up, and went out on a social event once, though left early. She has been grocery shopping with a friend, which she enjoyed. | |||||||||
| Travel | 2 | She is not driving, and has not used her new car she had bought. She goes to the local shops herself, if she needs to. She has not been to Sydney to visit her son in over a year. | |||||||||
| Social functioning | 1 | She has been maintaining regular contact with her friends and children and her brothers. | |||||||||
| Concentration, persistence and pace | 3 | Her concentration has improved, though still not the best. She can finish reading a newspaper article, though she has to re-read a few times and struggles to sustain concentration. | |||||||||
| She demonstrated extreme impairment with rote-learning, and average with spontaneous recall and with prompting. Her attentional capacity was in the average range. | |||||||||||
| Employability | 3 | She has been working at an Op Shop, for 38 hours a week. She said she hasn’t had to use her brain too much, and it was simple and less pressure, and she has been doing it for a week. She was able to do reasonably well for that week. | |||||||||
| Score | Median Class | ||||||||||
| 1 | 2 | 2 | 3 | 3 | 3 | =2.5 = 3 | |||||
| Aggregate Score Impairment | Total | % | |||||||||
| +1 | +2 | +2 | +3 | +3 | 3 | 14 | 13% | ||||
The worker appealed. In summary the appellant submitted that the Medical Assessor erred in his assessment under one of the PIRS categories, namely Social Functioning when he assessed a Class 1 and a Class 2 should have been assessed.
In summary, Community Housing Ltd (the respondent) submitted that the Medical Assessor did not err or make an assessment on the basis of incorrect criteria and the MAC should be confirmed.
The role of the Medical Assessor is to conduct an independent assessment on the day of examination. The Medical Assessor is required to take a history, conduct a mental state examination, make a psychiatric diagnosis and have due regard to other evidence and other medical opinion that is before the Medical Assessor. The Medical Assessor must bring his clinical expertise to bear and exercise his clinical judgement when making an assessment of impairment under the PIRS categories. The assessment is not to be based upon self-report alone. An appeal panel cannot disturb ratings under the PIRS scale for mere difference of opinion but must be satisfied as to error.
The Medical Assessor took a history which was broadly consistent with the other evidence before him. He recorded in detail the appellant’s reporting of present symptoms and impact on activities of daily living (ADLs). The Medical Assessor recorded as follows:
“Brief history of the incident/onset of symptoms and of subsequent related events, including treatment:
She said that on the 24 June 2021, she was travelling to see clients, whom she was doing on behalf of a colleague who was away. She was the front seated seatbelted passenger, and they pulled up to an intersection, and the driver pulled up in front and a car hit them on the driver’s side, and the car spun. She said she recalled tensing, as she saw it coming and thought she would die, and she cannot recall hitting her head, and couldn’t get out of the car, and her legs hurt afterwards, and she cannot recall losing consciousness. The airbags didn’t deploy.
They rang the police, and they did not attend the scene. The ambulance stopped and offered to help, but they didn’t think there was any injury, so they waved them off.
She did not return to her previous work after the accident and she is on WorkCover until recently.
She said that she then developed symptoms that night on returning home. She said she was in “shock” and that “I just wasn’t me”, and felt “sick in the guts”. She then developed headaches, body aches, reduced appetite, and pain in her shoulders. She was shaking, couldn’t stop crying. Her mood was “upset”, constantly there, and she couldn’t enjoy much. She was on quetiapine to help her sleep, and she had to increase it for a while. She had some night sweats, but no nightmares. She said that she lost a lot of weight, though she wasn’t sure how much. She said that her energy was low. She said that her concentration and memory was worse and she had to start writing everything down. She had suicidal thoughts, which she said was “I didn’t know why I was feeling that way, and I had stopped talking to my kids, or reaching out to anyone, and I would be better off…” She overdosed of her quetiapine in September 2021. Her mood was at its worse at the time, and she spent two weeks in a mental health unit, and she started to improve a month later. She was having a lot of anxiety, and worried about everything. She couldn’t shower or wash a dish, or leave the house or shopping, or see anyone. At the time, she had memories of the accident recur, when she would hear tyres screech or spontaneously. She denied any nightmares of the accident. She was avoiding driving, or shopping. She was more detached from others and positive emotions. She was more irritable, with sleep disturbance and vigilance. Her concentration was poorer as well.
She had been diagnosed with PTSD, Major Depressive Disorder and whiplash.
In terms of treatment, she saw her GP, Dr Sam Bright initially. She had CT scans of her body, which she said showed inflammation in the spine. She had remained on fluvoxamine 50mg prior to the subject accident, and it was increased when she was admitted to Taree hospital to 100mg daily, and she continued on the quetiapine. She also started seeing her psychologist about August 2021. She has also seeing a physiotherapy, and having acupuncture for her pain.
Present treatment:
She has a regular GP, Dr Sam Bright, whom she sees every 4 weeks.
She has a psychologist, Kathleen Lindsay, whom she sees every 2 weeks, and soon to reduce to monthly. She said that they talk about her coping mechanisms, and her day to day life.
She doesn’t see any other health professionals.
She is on:
Fluvoxamine 100mg daily
Quetiapine 25mg daily
Present symptoms:
She thinks there has been improvement of the pain, and she still has some pain in her neck “every now and then” when she is driving “like having rubber bands”, more discomfort than pain, and she is not on any analgesia, and she tries to loosen it with exercises.
She said that her mental state has started to improve in the last three months. Her mood has been “pretty happy” and she has been able to enjoy things. She has been sleeping well, and continues to take the tablets. Her appetite has been reduced, and she feels she has to force herself to eat and has two meals a day. She has not regained the weight she has lost. She said her energy levels have improved, though she has to put in effort to get going. Her concentration comes and goes, and she has been able to watch “Who wants to be a Millionaire”. She denied any hopelessness or guilt. She denied any suicidal ideations.
She still has a bit of unease, with returning to work at the Op Shop. She denied any recurrence of the recollection recently, except when she went past the location of the accident, and she went pale and was shaking and sick. She has been less irritable, and still less detached with positive emotions. She has been able to reach out to friends, but not as much as before, and has only gone to a social event once, and left early.
Details of any previous or subsequent accidents, injuries or condition:
Prior to her subject accident, she has had depression. This started when she was after 40 years old, when she had lost a business and struggled. The depressive episode lasted about 6-9 months, with pervasive depressed mood, intact reactivity, with sleep disturbances, appetite disturbance, and no suicidal ideations. She was treated with fluvoxamine, and she had a brief period of counselling for a few weeks. The depressive episode resolved by a few months with treatment.
She denied any other pre-existing psychiatric conditions, including anxiety disorders, PTSD.
She denied any pre-existing treatment apart from the counselling and fluvoxamine.
She used to smoke, and would drink alcohol on weekends. There was an escalation after the subject accident, to drinking 2-3 glasses a night, though this has reduced to one glass a night, sometimes 2-3 glasses. There has not been any functional impairment.
She has previously experimented with cannabis in her 20’s. There is no ongoing substance use.
She denied any forensic history.
She denied any family history of relevant mental health conditions.
She was born in Mona Vale, with no perinatal issues, developmental issues, childhood issues. Her father was a truck driver and her mother stayed at home. They were good to her when she was young, though they were poor and lived in housing commissions. She denied any traumatic experiences.
She was able to make friends easily at school. She had some bullying at school, but nothing significant. In the classroom, she was able to sit still and pay attention. She finished Year 11, and went to do an Australian traineeship in book-keeping at TAFE.
She separated with the father of the children 8 years ago. She denied any recent relationship issues.
General health:
Prior to the subject injury, she had psoriasis, anaemia.
Work history including previous work history if relevant:
She has worked for Coffs City Council in administrative work for 10 years, and then travelling while working in pubs throughout Australia, then ran a few pubs, and then she worked for the Department of Housing at Front Desk for 3 years, and then Community Housing as a tenancy worker where she would see clients to ensure they were going ok and the house was in good conditions, and she started that in November 2018. She denied any work performance or disciplinary matters, or previous WorkCover claims. She said she was being overworked and she had the biggest portfolio and she had been raising concerns with her bosses.
Social activities/ADL:
She currently lives at Coffs Harbour alone. Her parents have deceased. She has two children, Dominic 19 years old, and Molly 16 years old. She has five brothers. She has many good friends, and she maintains contact with them. She usually enjoys looking after her dogs, going for a walk along the beach.
She has started working last week, for the first time after a year, and at a LifeLine shop as a shop coordinator.
She has been able to look after herself, including showering daily without prompting, except on weekends if she has nothing on. She has been able to buy frozen meals, and cooking for herself, whereas she would cook for herself more and would enjoy that. She cleans her house and keeps it clean.
She has been able to catch up with friends, who picked her up, and went out on a social event once, though left early. She has been grocery shopping with a friend, which she enjoyed.
She is not driving, and has not used her new car she had bought. She goes to the local shops herself, if she needs to. She has not been to Sydney to visit her son in over a year.
She has been maintaining regular contact with her friends and children and her brothers.
Her concentration has improved, though still not the best. She can finish reading a newspaper article, though she has to re-read a few times and struggles to sustain concentration.
She has been working at an Op Shop, for 38 hours a week. She said she hasn’t had to use her brain too much, and it was simple and less pressure, and she has been doing it for a week. She was able to do reasonably well for that week.”
The Medical Assessor conducted a mental state examination and recorded his findings as follows:
“She was groomed and engaged well in the interview, and was forthcoming with her responses.
Her mood has been good, and she has been able to feel happy. Her affect appeared congruent, and she was euthymic.
She was articulate with her speech.
She was logical with her thought form.She had no suicidal ideations, and no longer having depressive cognitions.
She was alert, and had complaints of difficulties with concentration, though overall this has improved.”
The Medical Assessor noted the results of the special investigations as follows:
“She undertook cognitive screening (RBANS), with an embedded performance validity test (Effort Index). She appeared to be exerting sufficient effort on the Effort Index, and she demonstrated extreme impairment with rote-learning, and average with spontaneous recall and with prompting. Her attentional capacity was in the average range. Her estimated general cognitive ability was in the average range, based on a demographic-based algorithm.
She also undertook a performance validity testing of psychiatric symptoms (M-FAST), and she passed this.”
The Medical Assessor made a diagnosis as follows:
“summary of injuries and diagnoses:
She has a Major Depressive Disorder, in remission and Post-Traumatic Stress Disorder, in remission
· consistency of presentation
Her presentation today was consistent internally, and also compared to the medical records provided to me, and with the presumed mechanism of injury. She also passed a performance validity test and an effort index of cognitive performance.”
The Medical Assessor explained his reasons for assessment under each of the PIRS categories as set out in the table above. Only the assessment in the category of social functioning is the subject of complaint on appeal.
The Medical Assessor also provided reasons for his assessment as follows:
“She has a 13% whole person impairment.
In making that assessment I have taken account of the following matters: -
Statement by Susan Winnacott, dated 26 October 2021. She was working as a Housing Officer for Community Housing Limited, from November 2018. She has had a previous motor accident on 24 June 2021, while at work. She had anxiety related to work, prior to the motor accident due to pressure of work in the preceding 12 months, with an increased work load, abuse from tenants, fears for her safety and feeling her concerns being dismissed by her manager, and she had taken two days off work due to this, 2 weeks prior to the subject accident. She was the front seat passenger, and it was driven out of the intersection, in front of a white utility, which impacted the rear of the driver side, the car spun around. She notified her boss and the police, and picked up by a co-worker. She felt anxious and had a sore foot, and the next day she was sore all over and could not stop shaking. She saw her GP, Dr Sam Bright. She had pain in her neck and back and head, and she had scans and saw a physiotherapist, a return to work coordinator and EAP psychologist. She was diagnosed with concussion, back and neck sprain. She had a pre-existing depression, and had been on antidepressants for 7 years after a separation and financial bankruptcy, prior to the motor accident. She was continued on her antidepressants. She has not been able to return to work due to the anxiety caused by work, prior to the motor accident. She had an admission to a private hospital on 6 October 2021, and her antidepressant was increased. She attempted to return to work on 12 August 2021, from home, but she felt she could not do this, and only sustained her work for an hour and she felt pushed to complete her KPIs. She had not received a bonus due to not meeting KPIs, when the subject accident happened, but this was later paid. She feels angry, stays at home, and stopped talking to friends and family, and feels broken.
Statement by Susan Winnacott dated 24 June 2021. She has had depression 7 years prior to the subject accident, due to a business collapse and relationship collapse, and she was treated with fluvoxamine 100-150mg and quetiapine 25mg and counselling, and she said the depression remitted and she went back to work and her usual activities of daily living. She had an increase of workload from December 2020, due to reduced staffing, and she felt it was difficult to keep up with the workload and targets, and she was abused by the tenants and she felt very stressed from this. She had raised concerns with her manager, which she felt was being dismissed. She had two days off work on 8 June 2021, due to her stress. She had a motor accident on 24 June 2021, after which she felt sore, depressed and increasingly anxious. She saw her GP, and a psychologist and was diagnosed with major depressive disorder, anxiety and post-traumatic stress disorder. She has been unable to return to work, and has obtained alternative employment in administrative work. She has ongoing symptoms of poor concentration, depression, anxiety, being withdrawn, hopeless, with reduced appetite and weight loss.
Patient Health Summary, dated 23 February 2022 and clinical notes. She was on fluvoxamine 200mg daily, quetiapine 25mg nocte. She had a history of depression, anxiety. She had a new job on 7 February 2022, and felt she was back to normal head space. She felt optimistic 10 January 2022.She had a panic attack on 17 December.
IME report by Dr Nabil Malik, dated 5 November 2021. There was a history of depression prior to the subject accident, treated with fluvoxamine and quetiapine and she denied seeing a psychiatrist or psychologist at the time. After the subject accident, there was deterioration of her mental state, with symptoms of depression, anxiety and PTSD, with a two week admission to Taree Mayo hospital for suicidal ideations. She was diagnosed with PTSD, depression and anxiety. She was treated with fluvoxamine 200mg daily, quetiapine 25mg daily. She was better with her symptoms, but has ongoing symptoms of depression, PTSD and memory problems. She was given a diagnosis of Post-Traumatic Stress Disorder and Major Depressive Disorder. He recommended GP monitoring, psychological interventions, psychiatric reviews, and pharmacological options.
Outcome measures on 14 December 2021, with PCL-5 18/80, DASS-21 with severe depression, moderate anxiety and stress, and AUDIT 8.
IME report by Dr Patrick Morris, dated 5 April 2022. He diagnosed her with Major Depressive Disorder in partial remission, and disagreed with Dr Malik that the subject accident met Criterion A for Post-traumatic stress disorder. She had a positive prognosis with improvement with treatment, and she was coping working 20 hours a week in an administrative position. She has ongoing depressive symptoms.
Impairment Assessment by Dr Patrick Morris, dated 5 April 2022. She had a WPI 15%, with self care class 2, social activities class 3, travel class 2, social function class 2, concentration class 3, and employability class 3.
On assessment
· Present symptoms:
She thinks there has been improvement of the pain, and she still has some pain in her neck “every now and then” when she is driving “like having rubber bands”, more discomfort than pain, and she is not on any analgesia, and she tries to loosen it with exercises.
She said that her mental state has started to improve in the last three months. Her mood has been “pretty happy” and she has been able to enjoy things. She has been sleeping well, and continues to take the tablets. Her appetite has been reduced, and she feels she has to force herself to eat and has two meals a day. She has not regained the weight she has lost. She said her energy levels have improved, though she has to put in effort to get going. Her concentration comes and goes, and she has been able to watch “Who wants to be a Millionaire”. She denied any hopelessness or guilt. She denied any suicidal ideations.
She still has a bit of unease, with returning to work at the Op Shop. She denied any recurrence of the recollection recently, except when she went past the location of the accident, and she went pale and was shaking and sick. She has been less irritable, and still less detached with positive emotions. She has been able to reach out to friends, but not as much as before, and has only gone to a social event once, and left early.
She has been able to look after herself, including showering daily without prompting, except on weekends if she has nothing on. She has been able to buy frozen meals, and cooking for herself, whereas she would cook for herself more and would enjoy that. She cleans her house and keeps it clean.
She has been able to catch up with friends, who picked her up, and went out on a social event once, though left early. She has been grocery shopping with a friend, which she enjoyed.
She is not driving, and has not used her new car she had bought. She goes to the local shops herself, if she needs to. She has not been to Sydney to visit her son in over a year.
She has been maintaining regular contact with her friends and children and her brothers.
Her concentration has improved, though still not the best. She can finish reading a newspaper article, though she has to re-read a few times and struggles to sustain concentration.
She has been working at an Op Shop, for 38 hours a week. She said she hasn’t had to use her brain too much, and it was simple and less pressure, and she has been doing it for a week. She was able to do reasonably well for that week.”
The Medical Assessor had regard to the findings on mental state examination and the results of the special investigations.
The Medical Assessor had regard to the other evidence that was before him upon which he made brief comments explaining where he disagreed with the assessment of Dr Morris, the IME qualified on behalf of the appellant as follows:
“I disagreed with Dr Patrick Morris regarding Criterion A not being met, as at the time of the subject accident, she was bracing herself, and fearful of dying from an impending car crash, and thus meets Criterion A. The other manifest symptoms of PTSD met the subsequent criteria for the PTSD diagnosis as per DSM-5, and thus concur with Dr Malik’s assessment.
Since the assessment by Dr Morris, she has had further improvement of her mood, and it seems she has returned to more regular contact with her social network at her psychologist’s prompting, hence the improvement of her social functioning, which is discrepant with Dr Morris’ findings.”
The appellant complains that the Medical Assessor has erred in respect of one of the categories assessed, namely, Social Functioning. The Medical Assessor assessed Class 1, no deficit or minor deficit attributable to normal variation in the population. The appellant says a Class 2 should have been assessed.
The Panel cannot interfere with the ratings ascribed by the Medical Assessor to the category of Social Functioning absent error by the Medical Assessor . The Panel cannot interfere with the rating because opinions might differ as to the best fit in this category. There must be error or assessment on the basis of incorrect criteria.
In respect of Social Functioning, Table 11.4 of the Guides provides as follows:
“Table 11.4: Psychiatric impairment rating scale – social functioning
Class 1
No deficit, or minor deficit attributable to the normal variation in the general population: No difficulty in forming and sustaining relationships (eg a partner, close friendships lasting years).
Class 2
Mild impairment: existing relationships strained. Tension and arguments with partner or close family member, loss of some friendships.
Class 3
Moderate impairment: previously established relationships severely strained, evidenced by periods of separation or domestic violence. Spouse, relatives or community services looking after children.
Class 4
Severe impairment: unable to form or sustain long term relationships. Pre-existing relationships ended (eg lost partner, close friends). Unable to care for dependants (eg own children, elderly parent).
Class 5
Totally impaired: unable to function within society. Living away from populated areas, actively avoiding social contact.”
The Medical Assessor assessed Class 1 with the following reasoning:
“She has been maintaining regular contact with her friends and children and her brothers.”
The appellant submitted that the Medical Assessor should have assessed a mild impairment at Class 2.
The Appeal Panel considers that an assessment of no deficit accords with the criteria in that Class. Social functioning is not the same as social and recreational activities. The classes are distinguishable because social functioning is concerned with the quality of the relationships able to be maintained by the appellant after injury and social and recreational activities refers to the activities of a social and recreational nature able to be undertaken by the appellant. The submissions of the appellant direct themselves to these social and recreational activities. The appellant has been able to maintain regular contact with her friends, children and her brothers. Minor deficit attribute to normal variation in the population as found by the Medical Assessor is the best fit. The appeal panel can discern no error in the Class 1 rating.
For these reasons, the Appeal Panel has determined that the MAC issued on
12 October 2022 should be confirmed.
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