3.2 Grounds 4, 5 and 6: the Tribunal's application of the "clinical judgment" impairment evaluation method in Section 1.5, the AMA5 Guide
87 It will be recalled that Grounds 4 and 5 of the amended notice of appeal allege that the Tribunal misconstrued the "clinical judgment" impairment evaluation method, and lacked power to assess the degree of permanent impairment suffered by Ms Wuth using its own (lay) "clinical judgment". Ground 6 raises the question of whether, in so doing, the Tribunal acted in breach of procedural fairness. As to the latter, it was rightly not in issue that the Tribunal was required to comply with the requirements of procedural fairness. That said, the precise content to be given to the requirement to accord procedural fairness and the question of whether it has been breached will depend upon the facts and circumstances of the particular case, including the relevant statutory framework: SZBEL v Minister for Immigration and Multicultural and Indigenous Affairs [2006] HCA 63; (2006) 228 CLR 152 (SZBEL) at [26] (Gleeson CJ, Kirby, Hayne, Callinan and Heydon JJ).
88 Before turning to consider these grounds, I note that, both before the Tribunal and the primary judge, Comcare's arguments regarding Chapter 18 of the AMA5 and the application of Section 1.5 were intertwined. It was therefore in the context of finding that Chapter 18 of the AMA5 was intended to result in a principled qualitative (and not a quantitative) assessment, and that the Tribunal had therefore not misconstrued Chapter 18 of the AMA5, that the primary judge found that the Tribunal was entitled to use its own "clinical judgment" to assess Ms Wuth in accordance with Chapter 18 of the AMA5 (Wuth (FCA) at [76] - [79]). On appeal Comcare abandoned its argument regarding Chapter 18 of the AMA5. As a consequence, the argument regarding the Tribunal's application of "clinical judgment" assumed a different emphasis on the appeal from that before the primary judge.
89 Section 28(1) of the SRC Act provides that Comcare may prepare a Guide to the Assessment of the Degree of Permanent Impairment setting out:
(a) criteria by reference to which the degree of the permanent impairment of an employee resulting from an injury shall be determined;
(b) criteria by reference to which the degree of non-economic loss suffered by an employee as a result of an injury or impairment shall be determined; and
(c) methods by which the degree of permanent impairment and the degree of non-economic loss, as determined under those criteria, shall be expressed as a percentage.
90 A Guide prepared under subs (1) or a variation or revocation of such a guide under subs (2) must be approved by the Minister and is a legislative instrument once so approved (subs 28(3) and (3A) of the SRC Act). Section 28(4) of the SRC Act provides that:
Where Comcare, a licensee or the Administrative Appeals Tribunal is required to assess or re-assess, or review the assessment or re-assessment of, the degree of permanent impairment of an employee resulting from an injury, or the degree of non-economic loss suffered by an employee, the provisions of the approved Guide are binding on Comcare, the licensee or the Administrative Appeals Tribunal, as the case may be, in the carrying out of that assessment, re-assessment or review, and the assessment, re-assessment or review shall be made under the relevant provisions of the approved Guide.
(emphasis added)
91 The use of the word "shall" makes it clear that applying the relevant provisions of an approved Guide is a mandatory obligation imposed upon Comcare and the Tribunal.
92 Under the heading "Principles of Assessment" in Part 1 of the approved Guide, Principle 12 provides that:
In the event that an employee's impairment is of a kind that cannot be assessed in accordance with the provisions of Part 1 of this guide, the assessment is to be made under the American Medical Association's Guides to the Evaluation of Permanent Impairment 5th edition 2001.
An assessment is not to be made using the American Medical Association's Guides to the Evaluation of Permanent Impairment for:
…
chronic pain conditions, except in the case of migraine or tension headaches..…
Any reference in this guide to the American Medical Association's Guides to the Evaluation of Permanent Impairment is a reference to the 5th edition 2001.
93 By operation of s 14(1)(b) of the Legislation Act 2003 (Cth), as then in force, the effect of Principle 12 of the approved Guide is, relevantly, to incorporate without modification the AMA5 to cases of migraine or tension headaches. As such, as Comcare submitted, the AMA5 binds Comcare and the Tribunal in the same way as if it were a part of the approved Guide.
94 Relevantly, as earlier explained, Section 1.5 of the AMA5 provides that:
In situations where impairment ratings are not provided, the Guides suggests that physicians use clinical judgment, comparing measurable impairment resulting from the unlisted condition to measurable impairment resulting from similar conditions with similar impairment of function in performing activities of daily living.
95 In "suggest[ing]" that physicians use clinical judgment, it is plain from the context that the text is not suggesting that others might use clinical judgment, but is rather a suggestion to physicians as to how they might undertake the necessary comparison in situations where no impairment ratings are provided. As such, as Comcare submits, the AMA5 permitted only a physician to use clinical judgment, and did not permit the decision-maker independently in the absence of any expert evidence to compare the unlisted condition with an allegedly similar impairment that was measurable.
96 Comcare also submitted that the Tribunal had acted in breach of procedural fairness in undertaking this comparison independently of any expert evidence. In this regard, while Ms Wuth submitted before the Tribunal that it should exercise its own clinical judgment, and indeed the Tribunal understood that the use of clinical judgment was opposed by Comcare (Tribunal reasons at [50] - [51] (quoted at [58] above)). It was not in issue that none of the medical practitioners had given evidence on any comparison between Ms Wuth's condition and Tables 13.2 and 13.3 of the AMA5, despite the Tribunal ultimately undertaking this exercise. Nor did Ms Wuth submit before the Tribunal that the clinical judgment which she urged the Tribunal to undertake should be done by reference to these tables. Furthermore, the Tribunal is not a specialist tribunal comprised of experts in the medical field; nor was there any requirement that the Tribunal be constituted by an expert in the relevant field in the present case. In those circumstances, Comcare's submission that the Tribunal acted in breach of the requirements of procedural fairness should be accepted.
97 In this regard, as Comcare submitted, the case is similar to that in Rodriguez v Telstra Corporation Ltd [2002] FCA 30; (2002) 66 ALD 579 (Rodriguez). In that case, the Tribunal had found that by September 1998 Mr Rodriguez's depressive disorder had ceased to be applicable to his employment, and was no longer an "injury" under the SRC Act. Mr Rodrigues submitted that the Tribunal, in so concluding, had substituted its own opinion for that of the medical experts or, put another way, the Tribunal's conclusion was unsupported by any evidence. In upholding the appeal, Kiefel J found that no medical expert had expressed the opinion arrived at by the Tribunal and none of the medical experts were questioned on the factual basis which underpinned the Tribunal's opinion (Rodriguez at [21]-[22]). Justice Kiefel also referred to the fact that the applicant tended to camouflage his depression, which in turn highlighted the complexity of the task as one requiring expert psychiatric evaluation (Rodriguez at [22]). Her Honour held that, "if a view is formed by a Tribunal which goes beyond the opinions expressed by the experts in evidence, fairness requires that it be disclosed and the parties permitted an opportunity to address it" (Rodriguez at [24]). This is so irrespective of whether the Tribunal member is medically qualified (Rodriguez at [24]).
98 Further, while accepting that the Tribunal is not bound by the rules of evidence and may inform itself as it thinks fit, her Honour held this does not mean that the rules of evidence are to be ignored. Rather, her Honour held that:
25. ….The more flexible procedure provided for does not justify decisions made without a basis in evidence having probative force: Pochi v Minister for Immigration and Ethnic Affairs (1979) 36 FLR 482, 492, referring to Consolidated Edison Co v National Labour Relations Board (1938) 305 US 197, 229; The King v War Pensions Entitlement Appeal Tribunal; Ex parte Bott (1933) 50 CLR 228, 256. The drawing of an inference without evidence is an error of law: Australian Broadcasting Tribunal v Bond (1990) 170 CLR 321, 355-356; Repatriation Commission v Maley (1991) 24 ALD 43 (Full Court). Similarly such error is shown when the Tribunal bases its conclusion on its own view of a matter which requires evidence. In Collector of Customs (Tasmania) v Flinders Island Community Association (1985) 60 ALR 717, 722 a Full Court of this Court held that it was unjustifiable, and therefore legally erroneous, for a Tribunal to base its conclusion upon its own understanding of traditional aboriginal concepts of community ownership and interests, in the absence of any evidence on the matter.
26. It may be said that expert evidence is sometimes over-utilised and is called in situations where an arbiter of fact is in a position to determine the matter for itself. Sometimes all that is necessary is for a method or process to be explained, so that the Court or Tribunal can then apply it to the facts it finds. On the other hand, there are cases where a whole question is, in effect, relegated to experts to give evidence upon it. This was such a case. The Tribunal was not put in a position where it could simply draw its own inferences. In an area which required an understanding of a disorder it could only receive the opinions, have the bases for them explained if they differed and apply logic to determine which were to be accepted.
99 Equally, it is plain that the Tribunal fell into error here in basing its conclusion at [64] as to the appropriate comparison upon its own views, when that was a matter requiring expert evidence. Not only in this regard does Section 1.5 of the AMA5 suggest that physicians use clinical judgment to undertake the relevant comparisons, but immediately thereafter Section 1.5 of the AMA5 explains that:
The physician's judgment, based upon experience, training, skill, thoroughness in clinical evaluation, and ability to provide the Guides criteria as intended, will enable an appropriate and reproducible assessment to be made of clinical impairment. Clinical judgment, combining both the "art" and "science" of medicine, constitutes the essence of medical practice.
100 In those circumstances, as Comcare submitted, it was incumbent upon the Tribunal to follow an approach akin to that agreed between the parties on appeal and ordered by the Court in Riley v Comcare [2011] AATA 674 and applied in Roxas v Comcare [2012] AATA 747, namely, that:
(i) having determined that there was no applicable Table for the applicant's impairment, the Tribunal should have referred to the Principles of Assessment in Part 1 of the Guide;
(ii) those Principles provide that in the event that an employee's impairment is of a kind that cannot be assessed in accordance with the provisions of Part 1 of the Guide, the assessment is to be made under the edition of the AMA Guides;
(iii) the AMA Guides provide that "in situations where impairment ratings are not provided, the Guides suggest that physicians use clinical judgement comparing measurable impairment resulting from the unlisted condition to the measurable impairment resulting from similar conditions with similar impairment of function in performing activities of daily living";
(iv) accordingly, if the tribunal is satisfied that neither guide provides a specific means by which the impairment can be assessed, the tribunal should consider evidence from doctors as to the degree of impairment suffered based on their clinical judgement (informed by considering the degree of impairment resulting from similar listed conditions in the relevant edition of the AMA Guides).
101 It is plain that the comparison between Tables 13.2 and 13.3 was ultimately a critical issue in the Tribunal's decision. However, it was not raised by the Tribunal in advance of its decision. Nor was sufficient notice given merely by an open-ended submission by Ms Wuth, made without reference to Tables 13.2 and 13.3, that the Tribunal may undertake its own clinical evaluation (see above at [58]). Equally the cryptic reference to the issue at [8.3] of Ms Wuth's submissions to the Tribunal was insufficient to give fair notice to Comcare. As such, Comcare was not afforded an opportunity to address or lead evidence on any new or changed issues arising by reason of the different basis on which the Tribunal ultimately decided the application. Yet, as McHugh J, for example, stated with respect to the rules of procedural fairness in Minister of State for Immigration and Ethnic Affairs v Teoh (1995) 183 CLR 273 at 311-312 (in dissent but in a passage approved by McHugh and Gummow JJ in Re Minister for Immigration and Multicultural and Indigenous Affairs; ex parte Lam [2003] HCA 6; (2003) 214 CLR 1 at [81]-[83] (Lam)):
In the absence of a clear contrary legislative intention, those rules require a decision-maker 'to bring to a person's attention the critical issue or factor on which the administrative decision is likely to turn so that [she or] he may have an opportunity of dealing with it.
See also e.g. Kioa v West (1985) 159 CLR 550 at 587 (Mason J); Saeed v Minister for Immigration and Citizenship [2010] HCA 23; (2010) 241 CLR 252 at [19] (French CJ, Gummow, Hayne, Crennan and Kiefel JJ); SZBEL at [25]-[32] (Gleeson CJ, Kirby, Hayne, Callinan and Heydon JJ); and SZSSJ v Minister for Immigration and Border Protection (No 2) [2015] FCAFC 125; (2015) 234 FCR 1 at [118] (Rares, Perram and Griffiths JJ); see also, by analogy, Seltsam Pty Ltd v Ghaleb [2005] NSWCA 208 (Seltsam) at [78] - [79] (Ipp JA (with whose reasons Mason P agreed at [2])).
102 It follows that the Tribunal should have advised the parties that it was concerned that the appropriate comparison should be undertaken by reference to Tables 13.2 and 13.3, and afforded them the opportunity to make submissions and lead expert medical evidence on the appropriateness of that comparison under the AMA5.
103 For these reasons, the primary judge, with respect, fell into error in finding that there was no breach of procedural fairness by the Tribunal.
104 Furthermore, I respectfully disagree with the primary judge's findings at [84]. Contrary to his Honour's view, I consider that no further evidence was required in order for Comcare to establish that the breach of procedural fairness resulted in a practical injustice: Lam at [37] - [38] (Gleeson CJ), [122] (Hayne J). As Comcare submitted, the Tribunal proceeded on a basis that was neither foreshadowed to Comcare, or could reasonably have been contemplated by it given that the approved Guide required evidence from a suitably qualified physician as to the appropriate comparison and that no such evidence was before the Tribunal. As such, Comcare was denied the opportunity to lead expert evidence on whether Tables 13.2 and 13.3 afforded an appropriate comparison applying the "clinical judgment" assessment methodology in Section 1.5 of the AMA5. It was therefore denied the opportunity to be heard which it ought fairly to have been given in the totality of the circumstances: Minister for Immigration and Border Protection v WZARH [2015] HCA 40; (2015) 256 CLR 326 at [55] (Gageler and Gordon JJ); see also by analogy Seltsam at [79] (Ipp JA (Mason P agreeing)).
105 Finally and in any event, as Comcare submits, it was not open to the Tribunal to undertake a clinical evaluation for itself without medical evidence on the comparison required, given the binding nature of the approved Guide, because the AMA5 (being incorporated into, and therefore part of, the approved Guide) made it clear that that process was to be undertaken by physicians.