Wollongong City Council v Needham
[2024] NSWPICMP 680
•24 September 2024
| DETERMINATION OF APPEAL PANEL | |
| CITATION: | Wollongong City Council v Needham [2024] NSWPICMP 680 |
| APPELLANT: | Wollongong City Council |
| RESPONDENT: | Tracey Jayne Needham |
| APPEAL PANEL | |
| SENIOR MEMBER: | Kerry Haddock |
| MEDICAL ASSESSOR: | James Bodel |
| MEDICAL ASSESSOR: | Margaret Gibson |
| DATE OF DECISION: | 24 September 2024 |
CATCHWORDS: | WORKERS COMPENSATION - Worker sustained injury to her right lower extremity, left upper extremity, and scarring; Medical Assessor (MA) assessed permanent impairment at 17% which included assessment of left ulnar nerve damage; appellant appealed on the grounds that the MA had made a demonstrable error in assessing ulnar nerve condition in the respondent’s left arm as that was not part of the dispute identified by the parties; whether there was lack of procedural fairness as neither party had considered the issue and arguments; appeal upheld; Medical Appeal Panel (Panel) issued a new Medical Assessment Certificate (MAC) assessing the respondent’s permanent impairment at 12% after deduction of the assessment by the MA of impairment as a result of the respondent’s ulnar nerve condition; respondent sought judicial review of the Panel’s decision; the Court held that the Panel had erred in concluding that assessment of the respondent’s upper extremity should be limited to assessment of impairment after arthroplasty of the elbow, upper extremity motion impairment due to lack of flexion and extension of the elbow joint impairment due to lack of pronation and supination; the MA had to look for signs of nerve impairment on his examination and had to make a diagnosis that he then had to take into account in arriving at the respondent’s permanent impairment; the Court ordered that the matter be remitted to be considered by a differently constituted Panel; Needham v Wollongong City Council and Skates v Hills Industries Ltd considered; Held – MAC confirmed. |
BACKGROUND TO THE APPLICATION TO APPEAL
On 7 June 2023, Wollongong City Council (the appellant/the Council) lodged an Application to Appeal Against the Decision of a Medical Assessor.
The medical dispute had been assessed by Dr Yiu-Key Ho, who issued a Medical Assessment Certificate (MAC) on 11 May 2023.
The Medical Assessor assessed the respondent’s (Ms Needham’s) whole person impairment (WPI) as 17%. The assessment comprised 3% WPI as a result of injury to the respondent’s right lower extremity and 14% WPI (including scarring/TEMSKI) as a result of injury to the respondent’s left upper extremity.
The matter proceeded through the appeal process to an Appeal Panel (the original Appeal Panel).
On 25 August 2023, the original Appeal Panel issued a Statement of Reasons for Decision of the Appeal Panel in Relation to a Medical Dispute (the Statement of Reasons).
The original Appeal Panel agreed with the appellant that the Medical Assessor made a demonstrable error in assessing impairment (ulnar nerve condition in the left arm) that was not part of the dispute identified by the parties; and it was unfair for the Medical Assessor to treat the ulnar nerve condition in the respondent’s left arm as resulting from the incident on 26 January 2020 without putting the issue to the parties. This resulted in a lack of procedural fairness, as neither party considered the issue and arguments, or had a chance to address them.
The original Appeal Panel revoked the MAC and issued a new MAC. The respondent’s WPI was assessed as 12%, comprising 3% as a result of injury to the respondent’s right lower extremity, 8% as a result of injury to the respondent’s right [sic: left] upper extremity, and 1% for scarring/TEMSKI.
The decision of the original Appeal Panel was the subject of judicial review proceedings in the Supreme Court, with judgment being delivered on 16 May 2024 in the matter of Needham v Wollongong City Council.[1]
[1] [2024] NSWSC 575 (Needham).
The relevant orders made by her Honour Schmidt AJ (leaving aside the costs order) were:
(a) the [original] Appeal Panel’s decision be set aside, and
(b) the matter be remitted to be considered by a differently constituted Appeal Panel.
Accordingly, this Appeal Panel is determining the matter according to law. The Appeal Panel is obviously bound by the orders made in the Supreme Court in Needham and has considered in detail the reasons provided in that judgment.
Rule 128 of the Personal Injury Commission Rules 2021 (the 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 Workplace Injury Management and Workers Compensation Act 1998 (the 1998 Act). An Appeal Panel determines its own procedures in accordance with r 128(1) of the 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
The respondent sustained injury to her left upper extremity (left elbow) and right lower extremity (right ankle) on 26 January 2020 when she suffered a fall.
The respondent claimed permanent impairment compensation in respect of 16% WPI as a result of injury to her left upper extremity, TEMSKI/scarring, and right lower extremity.
On 21 April 2023, the medical dispute was referred to the Medical Assessor. The body parts referred were the left upper extremity, the right lower extremity, and scarring (TEMSKI).
On 11 May 2023, the Medical Assessor issued the MAC referred to above.
The MAC was appealed on 7 June 2023 and proceeded to determination by the original Appeal Panel.
As noted above, the decision of the original Appeal Panel was set aside by the Supreme Court, and the matter remitted to this Appeal Panel to be determined according to law.
PRELIMINARY REVIEW
The Appeal Panel conducted a preliminary review in the absence of the parties and in accordance with the Procedural Direction PIC7.
The Appeal Panel was provided with the Medical Appeal brief, which included all the material sent to the Medical Assessor, the MAC dated 11 May 2023, and the decision of the Supreme Court in Needham. Having considered that material, the Appeal Panel is satisfied that the matter is capable of determination on the papers.
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.
The Appeal Panel also reviewed the decision of the Supreme Court in Needham.
SUBMISSIONS
The submissions of the parties were considered by the original Appeal Panel. It is necessary to refer to the submissions to enable an understanding of the decision of Schmidt AJ.
In summary, the appellant submitted that:
(a) Dr Drew Dixon, on whose report the respondent relied, did not assess the respondent’s ulnar nerve, or provide any diagnosis of that condition.
(b) Dr Stephen Rimmer, on whose report the appellant relied, did not diagnose or assess any condition affecting the respondent’s ulnar nerve.
(c) The respondent filed an Application to Resolve a Dispute, and under the heading “Permanent Impairment/Pain and Suffering” the body systems claimed were recorded as “Left upper extremity”, “right upper extremity” [sic: right lower extremity], and “TEMSKI/Scarring”.
(d) The referral issued by the Personal Injury Commission (Commission) on 21 April 2023 recorded “Body part/s referred: Left Upper Extremity, Right Lower Extremity, Scarring (TEMSKI).”
(e) In assessing permanent impairment of the left elbow, the Medical Assessor applied Tables 16-34 and 16-37 (ROM) (range of motion) and 16-27 for radial head replacement. He also assessed the respondent under Table 16-15 for her “ulnar nerve problem.” He assessed 8% upper extremity impairment for that condition.
(f) In explaining his assessment, the Medical Assessor relevantly noted on page 4 that his opinion was “different” to Dr Rimmer as he thought there was an ulnar nerve neuropathy. He also acknowledged that there was a difference in his assessment compared with Dr Dixon, as he found there to be a “problem with the ulnar nerve.”
(g) The respondent had not, at any stage, framed her claim under s 66 of the Workers Compensation Act 1987 as including any injury affecting the ulnar nerve. Accordingly, the Medical Assessor assessed the respondent for an injury/condition that was not the subject of a claim made by the respondent, had not been diagnosed or assessed by the independent experts, and had not been pleaded by the respondent.
(h) The referral must be viewed in the context of the claim made by the respondent. The reference to “Left Upper Extremity” was plainly a reference to the fracture to the left elbow, as that was the only injury she had claimed.
(i) On no view of the documentation before the Commission could it be argued that the respondent had claimed any injury, or impairment, in respect of the ulnar nerve. The medical dispute was limited to the fractured left elbow, fractured right ankle, and scarring.
(j) The Medical Assessor failed to give reasons for ascribing any impairment present in the ulnar nerve to the injury on 26 January 2020. Where neither independent expert had diagnosed an ulnar nerve condition, it was incumbent on the Medical Assessor to provide reasons for any conclusion that there was an ulnar nerve condition diagnosed, and on what basis that condition resulted from the injury.
(k) The MAC should be revoked, and a new MAC issued, removing the assessment provided for the ulnar nerve (8% upper extremity impairment). The balance of the MAC may be confirmed.
In reply, the respondent submitted that:
(a) A Medical Assessor is required to use his expertise and clinical experience to reach an independent decision as to the matters referred to him. His task is to make a determination that is in accordance with the whole of the medical evidence and his clinical findings. (Emphasis in original.)
(b) The Medical Assessor is not obliged to accept any medical opinion that has been put before him and his reasons may not be extensive or detailed.
(c) The Medical Assessor was right to diagnose that the respondent was entitled to an assessment in relation to the ulnar nerve problems in accordance with Table 16-15. There was no agreement that the respondent’s injury included the pathology, and nor had the Commission made a determination that this pathology formed part of the respondent’s pathology. Given this, the Medical Assessor had power to consider whether this pathology resulted from the injury and had the power to make a finding that it did.[2]
(d) The Medical Assessor did not make an error, and a difference of opinion does not constitute a demonstrable error.[3]
(e) The respondent disagreed that the Medical Assessor could not assess the degree of permanent impairment outside a so-called “range” between the assessments of Dr Dixon and Dr Rimmer. If there was evidence of an assessment using Table 16-15, the Medical Assessor was entitled to calculate the level of WPI.
(f) The appellant’s submissions cavilled with the findings of the Medical Assessor and there was no error discernible on the face of the MAC. The correct assessment criteria were addressed. There was nothing to rebut the presumption of regularity.
[2] Bindah v Carter Holt Harvey Wood Products Aust Pty Ltd [2014] NSWCA 264 (Bindah).
[3] Mahenthirarasa v State Rail Authority of New South Wales & Ors [2007] NSWSC 22.
FINDINGS AND REASONS
Decision of original Appeal Panel
On 25 August 2023, the original Appeal Panel provided its Statement of Reasons for its decision.
The original Appeal Panel stated that it was clear from the Reply and the reports of Dr Dixon dated 26 October 2021 that there was a dispute between the parties concerning the degree of permanent impairment in the respondent’s right ankle and left elbow as a result of the injury on 26 January 2020.
The original Appeal Panel went on to state that at no time had Ms Needham made a specific claim in respect of an injury to the ulnar nerve and impairment in the left arm as a result of injury to the ulnar nerve. Ms Needham’s claim in respect of the left elbow was restricted to assessment for impairment of the upper extremity after arthroplasty of the elbow, and assessment of upper extremity motion impairment due to lack of flexion and extension of the elbow joint impairment due to lack of pronation and supination.
The original Appeal Panel noted that Dr Rimmer’s assessment of WPI of the left upper extremity was based on restriction of range of motion for flexion, extension, supination, and pronation.
The original Appeal Panel agreed with the appellant that the Medical Assessor had made a demonstrable error in assessing impairment that was not part of the dispute identified by the parties.
Further, it was unfair for the Medical Assessor to treat the ulnar nerve condition in Ms Needham’s left arm as resulting from the incident on 26 January 2020 without putting the issue to the parties. This resulted in a lack of procedural fairness, as neither party considered the issue and arguments, or had the chance to address them.
The original Appeal Panel concluded that the assessment of the respondent’s left upper extremity should be limited to an assessment of the upper extremity after arthroplasty of the elbow, upper extremity motion impairment due to lack of flexion and extension of the elbow joint impairment due to lack of pronation and supination.
Therefore, the original Appeal Panel concluded that the assessment by the Medical Assessor of the respondent’s ulnar nerve condition was to be deducted from the assessment made in respect of the right [sic] upper extremity. That resulted in an assessment of 14% upper extremity impairment for the right shoulder [sic], which equalled 8% WPI.
In summary, the original Appeal Panel assessed Ms Needham as having 8% WPI of the left upper extremity, 1% for scarring/TEMSKI, and 3% WPI of the right lower extremity. Therefore, 8% for the left upper extremity was combined with 3% for the right lower extremity and 1% for scarring/TEMSKI, which resulted in a total of 12% WPI.
For the above reasons, the original Appeal Panel determined that the MAC issued on 11 May 2023 should be revoked and a new MAC issued.
The original Appeal Panel issued a new MAC in which the respondent’s WPI was assessed as 12%.
Decision of the Supreme Court
The respondent sought judicial review of the decision of the original Appeal Panel.
Ms Needham’s case
Ms Needham contended that what the Medical Assessor was required to assess, given her application and the referral, was the injuries she had suffered to her elbow and the resulting impairment of her left upper extremity. The Guidelines required that this turned on clinical assessment undertaken on the day of her examination, the Medical Assessor exercising his clinical judgment to determine a diagnosis, and then, when assessing her WPI, using the method of assessment that yielded the highest assessment.
The Medical Assessor found on examination not only Ms Needham’s obvious scarring and impairment resulting from the injury to the joint, but also positive signs of ulnar nerve damage. Ms Needham contended that, given the claim she was pursuing in respect of impairment of her upper extremity, that diagnosis had to be included in the Medical Assessor’s assessment in accordance with the Guidelines.
Ms Needham contended that the original Appeal Panel had erred in concluding that the impairment to her ulnar nerve, diagnosed by the Medical Assessor on the day of the examination, had to be excluded from the assessment. Resolving the medical dispute required taking into account the injury caused to Ms Needham’s ulnar nerve when she fell and injured her elbow when the impairment of her left upper extremity was assessed.
The Council’s case
The Council contended that the original Appeal Panel was correct in concluding that the medical dispute did not concern the ulnar nerve, such injury or any resulting impairment never having been claimed by Ms Needham.
The original Appeal Panel was also correct in concluding that the Medical Assessor had fallen into demonstrable error in including such injury in the assessment, it being his function to find the degree of impairment resulting from an injury found by the Commission to have been suffered: Bindah. Any dissatisfaction with the injuries found had to be pursued by an appeal under s 352 of the 1998 Act.
Decision of Schmidt AJ
In issue was whether, as Ms Needham contended, the original Appeal Panel erred in:
(a) wrongly applying what was decided in Skates v Hills Industries Ltd;[4]
(b) its delineation of the parties’ medical dispute as being confined to the impairment of Ms Needham’s elbow and not including any impairment resulting from damage to her ulnar nerve, despite Dr Scott [sic: Dr Dixon] and Dr Rimmer having considered whether any impairment had resulted from such injury;
(c) failing to comply with applicable Guidelines when undertaking the assessment, and
(d) not [sic] finding that the Medical Assessor had denied the parties procedural fairness by assessing injury to her ulnar nerve, without first putting that diagnosis to them.
[4] [2021] NSWCA 142 (Skates).
The parties agreed that it was the compensation claim letter in November 2021 [sic: 2022], the Council’s response, Ms Needham’s later application for assessment of the parties’ resulting medical dispute, the Council’s response to that application and all the accompanying documents, which established what Ms Needham had pursued and what the parties’ resulting medical dispute concerned, given what had been held in Skates.
In this case, what Ms Needham had pursued, both by the claim letter and the accompanying draft assessment application and by her final application, relevantly concerned permanent impairment of her left upper limb. The injuries she had suffered were described to have been “to her right ankle, facial bruising, broken nose, and left elbow.” The nature of those injuries and their ongoing consequences were more extensively disclosed in the accompanying documents, including in relation to the scarring and her ongoing nerve problems.
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 the reasons given in its dispute notice, the Council relied on Dr Rimmer’s assessment. He had concluded that the impairment he found related entirely to the alleged injury of the left elbow. His report established that, like Dr Dixon, he had considered, but not found, impairment resulting from nerve damage. That consideration accorded with the accompanying documents reflecting that Ms Needham had suffered more than injury to the bones in her elbow joint, necessitating the testing for impairment as the result of nerve damage.
The body parts referred by the delegate for assessment included, correctly, the “Left Upper Extremity”, and so the assessment was not confined to the left elbow. There was no suggestion that the insurer objected to this referral as going outside the parties’ medical dispute. It was this dispute that the Medical Assessor had to resolve.
This accorded with both Ms Needham’s claim and her application having been made in respect of impairment of her left upper extremity, not merely her left elbow. That reflected what the documents that accompanied her claim and application, as well as those on which the insurer relied, had dealt with. The result was that the medical dispute was also not confined to impairment of her elbow.
The accompanying documents did not permit the conclusion that Ms Needham’s claim in respect of impairment of her left upper extremity excluded the result of injury to her ulnar nerve, located as it is in the elbow, and also damaged as it appeared to have been when she fell.
The significant surgical repair that Ms Needham required for the damage done to the bones of her elbow joint, as well as the ongoing symptoms she suffered afterwards, were consistent with nerves also having been damaged, as was the resulting treatment she required. What was so “crystallised” as part of the medical dispute included the result of that damage. It thus could not be accepted that this dispute excluded any impairment resulting from injury to Ms Needham’s ulnar nerve.
That Ms Needham’s claim was not pursued in relation to all of the impairment of her upper extremity that resulted from her fall and the injury she suffered to her elbow, with the result that any nerve damage then suffered did not form part of the medical dispute, was not consistent with her written claim and application, or the documents that accompanied them. To the contrary, the documents explained why both Dr Dixon and Dr Rimmer tested Ms Needham to establish whether nerve damage had contributed to the impairment she had suffered.
While the Council was entitled to dispute Ms Needham’s claim, relying on the conclusions of Dr Dixon and Dr Rimmer, the statutory scheme did not empower it to confine the medical dispute by its response to her application for referral of her claimed impairment for assessment. Not even by contending that injuries to body parts found in the upper extremity, disclosed by accompanying documents, had not been relied on by Ms Needham. That was why it was the upper extremity that was referred for assessment, not just the elbow.
This reflected that the statutory scheme recognises that injuries that result in impairment can remain stable, improve, or deteriorate over time. The Medical Assessor’s conclusions were consistent with deterioration of the ulnar nerve damage.
A defendant such as the Council is free to advance its case about an injured worker’s claim, which has become the subject of a medical dispute. It cannot dictate what the subject of the medical dispute is. That is established by the documents accompanying the claim, the application and the responses it made. It is the dispute they crystallise that is referred for assessment.
The referred dispute was thus not confined to injury to Ms Needham’s elbow joint. It had to be resolved by application of the assessor’s clinical judgment, in order to arrive at a diagnosis. That required regard not only to what the accompanying documents revealed about the injuries Ms Needham had suffered, but also to the history she provided on examination and what that examination established, including by the testing the Medical Assessor undertook. Application of the Guidelines to what was diagnosed then led to a conclusion about the extent of the impairment, which resolved the medical dispute.
A Medical Assessor’s conclusions do not depend on opinions that other medical practitioners earlier formed, when they examined and tested the injured worker. It is rather the outcome of the Medical Assessor’s clinical judgment that resolves the parties’ dispute about their competing claims: Skates at [50].
In Ms Needham’s case, given all that was addressed in the accompanying documents, it must be accepted that the medical dispute encompassed the damage to her ulnar nerve, which the Medical Assessor’s testing established, and which he concluded had contributed to the impairment she had suffered as a result of the injury caused to her elbow when she fell.
It followed that the original Medical Panel erred in concluding that:
“the assessment of the upper extremity should be limited to an assessment of the impairment of the upper extremity after arthroplasty of the elbow, upper extremity motion impairment due to lack of flexion and extension of the elbow joint impairment due to lack of pronation and supination.”
Like Dr Rimmer, Dr Dixon had concluded that no impairment had resulted from nerve damage. But their conclusions about this were incapable of precluding Ms Needham from pursuing that aspect of her claim, given what she was still experiencing. Nor did their opinions remove from Ms Needham’s assessment application her claim for compensation in respect of any of the body parts in her left upper extremity that had been damaged as a result of the injury caused to her elbow when she fell.
“Medical dispute” is defined in s 319 of the 1998 Act to mean, relevantly, “a dispute in connection with a claim” about “the degree of permanent impairment of the worker as a result of an injury.” That raised a question of causal connection: Bindah at [110].
It is the injured worker who makes the claim. Ms Needham’s claim concerned impairment to her left upper extremity. That was not a matter for the Council to determine. Nor did the claim Ms Needham pursued require its consent.
The result of Ms Needham’s claim was that it was the degree of impairment she had suffered to her left upper extremity as the result of her fall and all the injury it caused to her elbow that the Medical Assessor had to consider, in accordance with the Guidelines, on the day of the examination, in order to resolve the medical dispute.
That was why the Medical Assessor undertook similar testing to that undertaken by Dr Dixon and Dr Rimmer in respect of impairment resulting from nerve damage. That he came to different conclusions, given what he found, which resulted in a clinical diagnosis at which they had not arrived, and, finally, different conclusions about Ms Needham’s WPI, having found that her ulnar nerve had been impaired, established no error.
It followed that it must be accepted that the original Medical Panel erred in upholding the Council’s appeal and excluding from the calculation of Ms Needham’s WPI the conclusions reached by the Medical Assessor about the contribution the damage to her ulnar nerve had made to the impairment of her upper extremity.
The Guidelines contemplate that there may be more than one method by which the degree of permanent impairment can be established. It was not finally suggested by the Council that the Medical Assessor had failed to comply with the applicable Guidelines in arriving at his conclusions. The Council’s case was rather that the ulnar nerve damage was irrelevant to the parties’ medical dispute and thus should not have been considered by the Medical Assessor at all, given what Dr Scott [sic] and Dr Rimmer had concluded.
The conclusions of Dr Dixon and Dr Rimmer did not determine the claim Ms Needham could pursue. Suffering as she seemingly still was the results of damage caused to her nerves when she fell and injured her elbow, she pursued, as she was entitled to do, the assessment of impairment of her upper extremity.
The result of this was that the Medical Assessor also had to look for signs of nerve impairment on his examination and, having found them on his testing, had to make a diagnosis that he then had to take into account in arriving at Ms Needham’s WPI, as the Guidelines required him to do.
The original Medical Panel did not examine Ms Needham, and so had to take into account the Medical Assessor’s findings. It was not he, but the original Medical Panel, that erred in concluding that damage to Ms Needham’s ulnar nerve did not arise to be considered on the assessment, on the grounds that it was not part of the medical dispute that had been referred.
That conclusion did not reflect what had been decided in Skates, or what the accompanying documents that had to be considered established about the real extent of the parties’ medical dispute.
The result was that the original Medical Panel’s decision must be set aside.
As for the original Medical Panel’s finding that procedural fairness had been denied, the Medical Assessor undertook the same testing as Dr Dixon and Dr Rimmer and, having concluded that Ms Needham had suffered the nerve damage he diagnosed, that had to be taken into account in the assessment of her resulting impairment. There can have been no practical injustice, as far as Ms Needham was concerned, in the Medical Assessor doing so in accordance with what the Guidelines then required.
As the principles required, the Medical Assessor took into account the views of both Dr Rimmer and Dr Dixon, on which the Council had relied, in coming to his conclusions. He also explained why he came to a different view. That there was any practical injustice for the Council as a result was not apparent.
The original Medical Panel considered that procedural fairness had been denied, which turned on its view that the ulnar nerve impairment was not part of the medical dispute, and the Medical Assessor not having given either party the chance to consider the issue, or advance and address arguments in respect of it.
Her Honour did not agree, given what the accompanying documents dealt with and the testing Dr Scott [sic] and Dr Rimmer had already undertaken as a result. Given what was referred for assessment, the same testing was undertaken by the Medical Assessor, with different results. That was contemplated by the Guidelines, as was the result at which he arrived, being different findings about impairment of Ms Needham’s upper extremity.
There was no procedural unfairness in what unfolded, given the Council’s acceptance that the assessment had been undertaken in accordance with the applicable principles, and given what the Medical Assessor had found.
Schimdt AJ found that the original Appeal Panel had erred in upholding the Council’s appeal and excluding from the calculation of Ms Needham’s WPI the conclusions of the Medical Assessor about the contribution the damage to her ulnar nerve had made to the impairment of her left upper extremity.
As this Appeal Panel is bound by the decision of the Supreme Court, the MAC must be confirmed.
The assessment of the Medical Assessor, which included his assessment of the contribution the damage to the respondent’s ulnar nerve made to the impairment of her left upper extremity, resulted in the issue of a MAC in which the respondent’s WPI was assessed as 17%.
For these reasons, the Appeal Panel has determined that the MAC issued on 11 May 2023 should be confirmed.
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