WORKERS COMPENSATION - Workplace Injury Management and Workers Compensation Act 1998; medical appeal; assessment of impairment arising from carpal tunnel syndrome; loss of range of motion and sensory loss in fingers of both hands; Tables 16-5, 16-6 and 16-7 of American Medical Association Guides to the Evaluation of Permanent Impairment, 5th ed; whether sensory loss absent, partial, or total; insufficient reasons necessitated re-examination; Held - Medical Assessment Certificate revoked.

1. On 1 May 2025, the appellant, Grid Electrical Services Pty Ltd, lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by Dr John Giles, a Medical Assessor, who issued a Medical Assessment Certificate (MAC) on 8 April 2025.
2. The appellant relies on the following ground 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. Mr Campbell has been a licenced electrician for many years. He commenced employment with the appellant in January 2018, working on a full time basis. His duties were all types of electrical work on commercial construction sites. As one would expect, this involves significant use of the hands. He developed carpal tunnel syndrome in both hands, with symptoms first appearing in January 2021.
2. He has sensory loss, with dexterity and grip strength loss in both hands. He has had carpal tunnel release on both hands which was not particularly effective in reducing symptoms.
3. Mr Campbell made a claim for lump sum compensation on the appellant which eventually came to the Personal Injury Commission (Commission) for determination. On 8 April 2025, the Medical Assessor issued a MAC certifying combined whole person impairment of 47%.
4. The appellant employer appeals against that assessment.

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. As a result of that preliminary review, the Appeal Panel determined that the worker should undergo a further medical examination because the Appeal Panel were satisfied that the MAC contained a demonstrable error. It was clear from a fair reading of the MAC that the Medical Assessor had not appropriately explained how he had reached his conclusion on sensory loss, and in particular which tables were used and whether Mr Campbell suffered from no, partial, or total loss.

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 Anderson of the Appeal Panel conducted an examination of the worker on 18 September 2025 and reported to the Appeal Panel. A copy of the report, including the findings on examination in tabular form, is included in the decision and follows.

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.
2. In summary, the appellant submits that the Medical Assessor failed to indicate how he formed his assessment for sensory loss, and which tables he utilised to reach his conclusion. The absence of sufficient reasons constitutes a demonstrable error. The appellant also identifies inconsistencies between the figures in the worksheet and the body of the MAC.
3. In reply, the respondent submits that the Medical Assessor has provided adequate reasons for the conclusion he has reached. The respondent concedes there is an inconsistency in the right and left thumb adduction assessments, but that the path of reasons is clear and the assessments of impairment of 29% and 26% are correct.

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. This appeal concerns the assessment of both upper extremities on the basis of the reasons provided by the Medical Assessor. Accordingly the Appeal Panel's consideration of the matter is limited to that issue (per Basten JA in Queanbeyan Racing Club Ltd v Burton [2021] NSWCA 304 at [26]):

"Secondly, s 328(2) requires that the review 'is limited to the grounds of appeal on which the appeal is made.' Because the gateway function of the Registrar is satisfied if 'at least one of the grounds' has been made out, it appears that the Appeal Panel is not limited to the ground held by the Registrar to have been made out, but may consider all grounds of appeal raised in the appellant's application. On the other hand, it is clear that the Appeal Panel is not permitted to look for errors which are not part of 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. As indicated above, after conducting a preliminary review, it was the Appeal Panel's view that a demonstrable error had been made out. The Appeal Panel accepts the appellant's submissions that it is unclear from the reasons which tables in Chapter 16 of AMA 5 the Medical Assessor has considered, and whether he has applied those tables correctly, with regard to sensory loss. In those circumstances, the Medical Assessor's reasons are insufficient to determine whether or not an error exists. An absence of, or the provision of insufficient reasons, constitutes a demonstrable error as it is readily apparent from the face of the MAC that such an error exists.
4. Accordingly, in order to properly determine the appeal, the Appeal Panel determined that it was necessary that the respondent be re-examined by a medical member of the Appeal Panel. That re-examination was conducted by Medical Assessor Tim Anderson, on 18 September 2025. The report of that re-examination is as follows:

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

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

There does not appear to be any particular additional history, although at this assessment, it was identified that Mr Campbell had particularly stiff wrists.

Mr Campbell was towards the lower end of average stature with a height of 1.69m. His weight was 95kg. With these parameters, he currently has a Body Mass Index of over 33kg/m² which is well inside the technical category of 'obese'. The upper level of healthy BMI is 25kg/m². In order to achieve this, he should be no more than 71kg. He was in a lot of discomfort with both of his hands and wrists.

Upper Limbs. As already advised, it was identified that Mr Campbell had significant dysfunction of his wrists.

He continues to have dysfunction of the fingers of both hands. The associated specific measurements of the three major finger joints (and of the thumbs) are also demonstrated in the associated impairment tables.

Sensory Dysfunction. Reduced sensation was demonstrated along the ulnar side of the right thumb along its full length and was assessed by two point discrimination as 'total'. With the left thumb, there was reduced sensation along the full length on both sides of the thumb. This, however, was assessed as 'partial'. The impairment of the thumb sensation has been addressed in AMA-5, Page 448, Table 16-6. (This table also addresses any sensory dysfunction of the little finger although with Mr Campbell's circumstances, no sensory dysfunction of the little fingers was demonstrated.)

Sensory reduction was demonstrated in the index, middle and ring fingers of each hand.

Right Index Finger. Total radial nerve sensory loss along the whole length (100%) of this finger.

Right Middle Finger. Partial radial digital loss was assessed along the full length (100%) of the finger.

Right Ring Finger. Partial transverse sensory loss was identified along the full length (100%) of the finger.

Right Little Finger. No sensory dysfunction was identified.

Left Index, Middle and Ring Fingers. Partial transverse sensory loss was identified along the full length (100%) of the left index, middle and ring fingers.

As with the right little finger, there was no sensory dysfunction of the left little finger.

The reduced sensation in the index, middle and ring fingers of both hands is addressed in AMA-5, Page 448, Table 16-7. (Table 16-6 is specifically for the thumbs and little fingers).

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

The following tables contain the assessments in accordance with AMA 5 and the Guidelines.

1. As can be seen from the above tables, as well as the body of the report, Mr Campbell's sensory dysfunction varies from finger to finger. Where sensory loss is present, it was either partial or total, but was present along the whole length of the finger.
2. The two point discrimination test was utilised in accordance with Table 16-5 to determine whether the sensory loss in each digit would be considered as none, partial or total. Tables 16-6 and 16-7 were then utilised to determine the digit impairment for the affected nerve in the affected digit. The figures are provided in each table, noting that there was no sensory loss in the little finger on each hand. This is in accordance with the instructions provided at 16.3d of AMA 5, on page 449.
3. It is noted that the figures on re-examination are higher than those recorded in the MAC, by the Medical Assessor at first instance. This is because there was a higher loss of range of movement on re-examination (consistent with the assessments taking place on different days and the clinical nature of the impairment from which Mr Campbell suffers), as well as a loss of sensation in more digits (consistent with the nature of Mr Campbell's injury and the progression of same). The Appeal Panel adopt the figures provided on re-examination for the determination of impairment of Mr Campbell.
4. For these reasons, the Appeal Panel has determined that the MAC issued on 8 April 2025 should be revoked, and a new MAC should be issued. The new 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 John Giles and issues this new Medical Assessment Certificate as to the matters set out in the Table below:

Chapter, page and paragraph number in NSW workers compensation guidelines

Chapter, page, paragraph, figure and table numbers in AMA 5 Guides

Proportion of permanent impairment due to pre-existing injury, abnormality or condition

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

Chap 2 P 10

P 467 F 16-28

P 469 F 16-31

P 461 F 16-21

P 463 F 16-23

P 464 F 16-25

P 456 F 16-12

P 457 F 16-15

P 459 F 16-8(a) and F 16-8(b)

P 460 F 16-9

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