WORKERS COMPENSATION - Workplace Injury Management and Workers Compensation Act 1998; review of Medical Assessment Certificate (MAC); injury to cervical spine, thoracic spine, right upper extremity, left upper extremity, and skin (scarring); claim for permanent impairment; Medical Assessor (MA) certified that worker had not reached maximum medical improvement (MMI) because of possible further treatment; worker appealed; Held - error found because MA failed to identify what the possible further treatment was and there was no evidence that the worker was having any more than physiotherapy, hydrotherapy, and muscle manipulation; re-examination considered necessary in the circumstances of error; MAC revoked.

1. The worker Hiam Ajaka (the appellant) lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by Dr Peter Honeyman, a Medical Assessor, who issued a Medical Assessment Certificate (MAC) on 24 March 2025.
2. 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 MAC contains a demonstrable error.
3. 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.
4. 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.
5. 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).

1. 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.
2. The appellant requested that she be re-examined by a Medical Assessor who was also a member of the Appeal Panel.
3. As a result of its preliminary review, the Appeal Panel determined that the worker needed to undergo a further medical examination because the Appeal Panel found error, and there was insufficient material before the Appeal Panel for it to make a determination.

1. 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.

1. Medical Assessor James Bodel of the Appeal Panel conducted an examination of the worker on 19 August 2025 and reported to the Appeal Panel.

1. 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.

1. Both parties made written submissions. They are not repeated in full, but have been considered by the Appeal Panel.

1. 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.
2. 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.
3. The matter was referred by the Personal Injury Commission (Commission) to the Medical Assessor as follows:
4. The following matters have been referred for assessment (s 319 of the 1998 Act):

• Body parts/systems referred: Cervical spine

• Method of assessment: Whole Person Impairment."

1. The Medical Assessor issued a MAC certifying that Maximum Medical Improvement (MMI) had not been reached.
2. The worker appealed against this certification on the basis that the Medical Assessor demonstrably erred in certifying that MMI had not been reached and that the Medical Assessor gave inadequate reasons for doing so.
3. In summary, the respondent employer APG & Co Pty Ltd ATF Beaujolais Unit Trust (the respondent) submitted that the MAC should be confirmed as there was no demonstrable error in the certification that MMI had not been reached.
4. 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 medical examination, make a 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 independent assessment of impairment and must apply the correct criteria for assessment under the Guidelines. This includes in respect of the certification of whether a worker has reached MMI to enable an assessment of permanent impairment to be made.
5. In this regard, the Guidelines provide at 1.15 and 1.16 as follows:

1.15 Assessments are only to be conducted when the medical assessor considers that the degree of permanent impairment of the claimant is unlikely to improve further and has attained maximum medical improvement. This is considered to occur when the worker's condition is well stabilised and is unlikely to change substantially in the next year with or without medical treatment.

1.16 If the medical assessor considers that the claimant's treatment has been inadequate and maximum medical improvement has not been achieved, the assessment should be deferred and comment made on the value of additional or different treatment and/or rehabilitation - subject to paragraph 1.34 in the Guidelines."

1. Clause 1.34 of the Guidelines concerns the refusal of treatment which is not applicable here.
2. The path of reasoning disclosed by the Medical Assessor must be adequate. The MAC must be read as a whole to determine whether adequate reasoning has been provided.
3. The Medical Assessor recorded the following history:

"● Brief history of the incident/onset of symptoms and of subsequent related events, including treatment:

On the date of injury, she slipped and fell onto the floor at work. She needed help to get up and subsequently presented for physiotherapy and onwards to the Doctor. She was off work for a week. She is a difficult historian to get a clear picture of what happened, but I understand she has seen a Neurologist and had nerve conduction studies. She has had no operations, and it is not clear why she was referred for an assessment of scarring. She is still seeing medical specialists and has an appointment on 31/03/2025 to follow up on advice and any future recommendation of treatment.

• Present treatment: Currently, she has stopped physiotherapy but continues to do hydrotherapy and massage. She is taking Gabapentin and Panadol Codeine.
• Present symptoms: Pain or soreness in the neck-shoulder from the mid thoracic spine upwards. She is working part-time casual 3 days for 4 hours. She also is complaining of intermittent tingling in the arms and the legs.
• Details of any previous or subsequent accidents, injuries or condition: She describes an injury on 12/12/2021 when she slipped on, she thinks grapes while in Coles. She said she continued the physical activity after this injury and the second slip was the more serious injury."

1. The Medical Assessor made the following comment in relation to special investigations and included references to the IME reports as follows:

1. Mild AC degeneration associated with a degree of synovitis.
2. Small SASD bursal effusion with some peribursal oedema signal. Is there clinical evidence of extrinsic impingement?
3. Supraspinatus tendinosis as detailed without MR evidence of a calcific tendinitis.
4. Heterogeneous insertional infraspinatus tendinosis with some degenerative fraying.
5. Evidence of chronic teres minor denervation with a pattern suggesting abhorrent pattern of axillary
nerve innovation.
6. Rotator interval > intra articular long head biceps tendinosis.

Partially healed SLAP 2 tear of the superior glenoid labrum.

There are treating notes that cover a wide range of varied symptoms:

16/6/22 and 27/6/23 Dr R Granot IMEs reports an array of symptoms without firm pathology. Initially suggested a migraine component, then soft tissue injury and perhaps reaction to the trauma of losing her son.

13/2/23 Dr Rimmer IME reported "overwhelmingly abnormal illness behaviour/she has become pain focused. Plus resolved soft tissue injuries."

13/2/23 Dr Patrick IME felt the fall had resulted in permanent impairments to shoulders, cervical and thoracic spine with 21% WPI.

1. The Medical Assessor conducted a physical examination and recorded the following findings:

"On examination, she walks without limp and has sat with normal posture and moved her arms normally about during the interview.

Examination of the cervical spine shows that she has side bending and rotation, left equals right. Flexion and extension are both restricted. She has normal posture and curves of the cervical spine. There was no suggestion of any neurological findings.

The thoracic spine is stiff with the usual amount of kyphosis. Muscle palpation of the thoracic and cervical spines was without abnormality, and she was mildly tender when pressing on the spinous processes from the neck to the mid thoracic region.

The lumbar spine had normal lordosis and was stiff, as expected for her age. Side bending and rotation to the left was equal with right. There was no paraspinal tenderness.

The shoulder movements were restricted but equal in range."

1. The Medical Assessor summarised the injury and diagnosis as follows:

My opinion is that she has not achieved MMI as she continues to have treatment, and she advised that there were further requests for further intervention to occur to assist her with her symptoms.

Ms Ajaka was co-operative throughout the assessment."

1. In relation to whether MMI had been reached the Medical Assessor stated as follows:

"Have all body parts/systems stabilised/reached maximum medical improvement?

No. She does not feel she has exhausted treatment and is still seeking additional treatment.

If not, please list those injuries not yet stable/at maximum medical improvement:

If stabilisation/maximum medical improvement, of any or all injuries has not been reached, when, in your opinion, will this occur?

"My opinion and assessment of whole person impairment:

Not at MMI. She should complete her medical management, then return for assessment 6 months post cessation of all proposed treatment.

In making that assessment I have taken account of the following matters:

Review of the material provided and a detailed examination of the claimant."

1. He has drawn the conclusion that MMI has not been reached despite taking a history that only physiotherapy and hydrotherapy are being undertaken as management for the referred injuries.
2. The ongoing treatment being undergone by the appellant is not significant. Moreover, the Medical Assessor has not identified in any way the proposed treatment upon which the certification of not having reached MMI has apparently been based. Identification of the proposed treatment is required by paragraph 1.16 of the Guidelines as set out above.
3. The Appeal Panel considers that the Medical Assessor has therefore fallen into error. This error necessitated a re-examination and Dr Bodel, a member of the Appeal Panel who is also a medical assessor was appointed to conduct the examination.
4. Medical Assessor Bodel examined the appellant and reported to the Appeal Panel as follows:

"1. The workers medical history, where it differs from previous records:

Ms Ajaka was examined for her Medical Assessment Certificate on

The examination was conducted by Dr Peter Honeyman, an Occupational Physician.

As you are aware, he declined to give a WPI rating, as he was of the view that, 'She has not achieved MMI as she continues to have treatment, and she advised that there were further requests for further intervention to occur to assist her with her symptoms.'

She indicates to me today, that since her medical assessment by

Dr Honeyman, she has been referred to Dr Peter Khong, a Spinal Surgeon, at St George Private Hospital. After examination, he indicated that there was no place for surgical intervention.

He advised continuing conservative care with hydrotherapy, massage (remedial massage which she self-funds every two weeks), and the medication including Gabapentin, Endep and Voltaren creams. Botox is being considered for the management of her headaches and her upper neck pain, but she is not keen to do so.

On careful history taking, Ms Ajaka has now completed any interventional treatment. She is unlikely to accept Botox injections or any other interventional injections, even radiofrequency neurotomies, and she certainly will not have surgery.

By definition, she has reached the level of Maximum Medical Improvement, and her level of Whole Person Impairment is unlikely to alter by more than 3% in the next 12 months.

1. Additional history since the original Medical Assessment Certificate was performed

The additional history is the fact that she has now completed the potential further treatment investigations and no further treatment has been offered.

The areas of assessable impairment are to the cervical spine, the thoracic spine, right and left upper extremities, and 'skin scarring.'

I observe that she is a very anxious person. Her husband accompanied her and I observe some restrictions of her spinal and shoulder movement.

She has asymmetry of movement and guarding in the cervical spine and dysmetria was present. There is a Cervical Category II level of assessable impairment. There is a restricted range of movement and dysmetria evident to the right-hand side 60%, and 80% of the expected range with dysmetria to the left.

There is a similar restriction of thoracic spine movement with 60% of the expected range of lateral bending to the right, and 80% of the expected range of lateral bending to the left.

In the lumbar spine, she has a good range of movement. She reaches forward in flexion with her hands to the knees. There is backache at this point and also on extension, with a restricted range of lateral bending to both sides, but this is symmetrical.

There is the rateable restriction of shoulder movement. This is variable on repeated observation, and I have encouraged her to give her best. The range of movement observed in that circumstance is as follows:

There is mild impingement in both shoulders. There is no instability.

There is no restriction of elbow, wrist or hand movement and grip strength is normal. There is no sign of radiculopathy in the upper limbs.

1. Results of any additional investigations since the original Medical Assessment Certificate

No additional investigations or other tests have been undertaken or reviewed here today.

The claimant has a rateable restriction of movement. I am satisfied that she meets the definition of Maximum Medical Improvement for the reasons outlined above.

Ms Ajaka has an interference in activities of daily living in accordance with item 4.34 and item 4,35 on page 28 of the workers compensation guidelines giving a 2% loading and a 7% WPI overall for the cervical spine.

This is due to inability to engage in sport and leisure activities and she needs domestic assistance provided by her husband and daughter.

The four ratings are combined using the Combined Value Charts on page 604 of AMA 5:

• 7% WPI for the Cervical Spine
• 6% WPI for the Right Upper Extremity
• 6% WPI for the Left Upper Extremity
• 5% WPI for the Thoracic Spine
• There is a 22% Whole Person Impairment.

There is no scarring and therefore a 0% rating under TEMSKI."

1. The Appeal Panel is satisfied that Medical Assessor Bodel has taken a through history that addresses that no treatment of any curative significance is proposed and he has conducted a thorough physical examination. The Appeal Panel adopts the findings and report of Medical Assessor Bodel.
2. This means that the Appeal Panel agrees with the certification that the appellant has reached MMI and will issue a certificate certifying her permanent impairment based on the examination findings of Medical Assessor Bodel as follows:

page and paragraph number in NSW workers compensation guidelines

Chapter, page, paragraph, figure and table numbers in AMA5 Guides

% WPI deductions pursuant to S323 for pre-existing injury, condition or abnormality

Sub-total/s % WPI (after any deductions in column 6)

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

1. For these reasons, the Appeal Panel has determined that the MAC issued on 24 March 2025 should be revoked. A new medical assessment certificate is attached to this statement of reasons.

This Certificate is issued pursuant to s 328(5) of the Workplace Injury Management and Workers Compensation Act 1998.

The Appeal Panel revokes the Medical Assessment Certificate of Medical Assessor Peter Honeyman and issues this new Medical Assessment Certificate as to the matters set out in the Table below:

page and paragraph number in NSW workers compensation guidelines

Chapter, page, paragraph, figure and table numbers in AMA5 Guides

% WPI deductions pursuant to S323 for pre-existing injury, condition or abnormality

Sub-total/s % WPI (after any deductions in column 6)

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

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.