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[2008] NSWCA 163
Court of Appeal (NSW)
2008-06-17
Allsop P, Giles JA, Basten JA, James J
Original judgment source is linked above.
CITATION: McKEE v ALLIANZ AUSTRALIA INSURANCE LTD [2008] NSWCA 163
JUDGMENT OF: Allsop P at 1; Giles JA at 10; Basten JA at 41
CATCHWORDS: ADMINISTRATIVE LAW - exercise of discretion by review panel - exercise of professional judgment by review panel - ADMINISTRATIVE LAW - grounds of review - scope of review - whether review panel restricted to considering matters identified in application for review - whether composition and nature of review panel affects scope of powers - MOTOR ACCIDENTS - medical assessment - powers of review panel under the Motor Accidents Compensation Act 1999 (NSW), s 63 - purpose and structure of Act - whether review panel restricted to considering matters identified in application for review - comparison of schemes for resolution of medical disputes by approved medical specialists under the Motor Accidents Compensation Act 1999 (NSW) and the Workplace Injury Management and Workers Compensation Act 1998 (NSW) - Motor Accidents Compensation Act 1999 (NSW) Part 3.4, s 63 - Workplace Injury Management and Workers Compensation Act 1998 (NSW) ss 326, 327 - STATUTORY INTERPRETATION - delegated legislation as an interpretation tool - whether guidelines on review procedures affect the scope of review panel's powers - WORDS & PHRASES - "review"
Interpretation Act 1987 (NSW), ss 33, 34 LEGISLATION CITED: Motor Accidents Compensation Act 1999 (NSW), ss 5, 6, 44, 57, 58, 59, 60, 61, 62, 63, 64, 65, 108, 131, 132, Parts 3.4, 4.4 Supreme Court Act 1970 (NSW), ss 69, 101 Workplace Injury Management and Workers Compensation Act 1998 (NSW), ss 319, 325, 326, 327, 328, 352, Part 7
Brandy v Human Rights and Equal Opportunity Commission [1995] HCA 10; 183 CLR 245 Campbelltown City Council v Vegan [2006] NSWCA 284; 67 NSWLR 372 Colpitts v Australian Telecommunications Commission (1986) 9 FCR 52 Kalil v Bray [1977] 1 NSWLR 256 Kioa v West (1985) 159 CLR 550 CASES CITED: NSW Thoroughbred Racing Board v Waterhouse [2003] NSWCA 55; 56 NSWLR 691 Parisienne Basket Shoes Pty Ltd v Whyte [1938] HCA 7, 59 CLR 369 Pitsonis v Registrar of the Workers Compensation Commission [2008] NSWCA 88 Siddik v WorkCover Authority of New South Wales [2008] NSWCA 116 State Transit Authority of New South Wales v Chemler [2007] NSWCA 249 SZBEL v Minister for Immigration and Multicultural and Indigenous Affairs [2006] HCA 63; 228 CLR 152 Tomko v Palasty (No. 2) [2007] NSWCA 369
John Charles McKee (Appellant) PARTIES: Allianz Australia Insurance Ltd (First Respondent) Motor Accidents Compensation Appeal Panel (Second Respondent) Motor Accidents Authority of New South Wales (Third Respondent)
C Jackson (Appellant) COUNSEL: J Griffiths SC/E Romniuk (First Respondent) Submitting appearances (Second and Third Respondents)
Rishworth Dodd & Co (Appellant) SOLICITORS: TL Lawyers (First Respondent) I V Knight, Crown Solicitor (Second and Third Respondents)
LOWER COURT JURISDICTION: Supreme Court
LOWER COURT DATE OF DECISION: 4 October 2007
LOWER COURT MEDIUM NEUTRAL CITATION: McKee v Allianz Australia Insurance Limited [2007] NSWSC 1067
IN THE SUPREME COURT OF NEW SOUTH WALES COURT OF APPEAL CA 40740/07 SC 30038/07
ALLSOP P GILES JA BASTEN JA
14 July 2008 John Charles McKEE v ALLIANZ AUSTRALIA INSURANCE LTD & ORS Headnote Following a motor vehicle accident on 9 June 2003, the appellant, Mr McKee, received injuries to both knees, his left shoulder and his spleen. He made a claim for damages, to which the respondent (Allianz Australia Insurance Ltd) was the defendant. The matter was referred for medical assessment, pursuant to ss 58(1) and 60 of the Motor Accidents Compensation Act 1999 (NSW) ('MAC Act').
On 23 June 2006, a medical assessor certified that the appellant's degree of permanent impairment was not greater than 10%, thereby disentitling him to damages for non-economic loss under s 131 of the MAC Act. The medical assessor allowed 1% permanent impairment for the left shoulder, 8% for impairment to the left lower leg and nothing for the injury to the right knee and the spleen. The appellant applied for review of the medical assessment on the basis that the assessor was incorrect in his assessment of the spleen injury: MAC Act, s 63(1). A proper officer of the Motor Accidents Authority of New South Wales referred the application to a review panel: MAC Act, s 63(3).
On 28 November 2006, the review panel accepted that the assessment of the spleen injury was incorrect and attributed 3% permanent impairment to this injury. The review panel also reassessed the medical assessor's percentage for the left knee and reduced it from 8% to 6%. The degree of permanent impairment of the appellant was reassessed at 10%. Since this figure was not greater than 10%, the appellant was still not entitled to damages for non-economic loss.
The appellant filed a summons in the Common Law Division of the Supreme Court seeking judicial review of the review panel's decision, pursuant to s 69 of the Supreme Court Act 1970 (NSW). On 4 October 2007, James J dismissed the summons. The Court of Appeal granted the appellant leave to appeal: Supreme Court Act, s 101(2)(r).
(i) whether the review panel erred in considering all aspects of the medical assessment, rather than only the spleen injury which was identified as an error in the appellant's application for review; and
(ii) whether the review panel erred in exercising their discretion (if any) about whether to review the entire medical assessment.
In relation to (i) (per Giles JA, Allsop P agreeing)
The text and structure of s 63 indicate that the review of a medical assessment by a review panel extends to the whole of the initial medical assessment, not just part of the medical assessment: [1], [6]-[7], [11], [25], [27].
Given the extra-curial nature of resolving medical disputes, particularly the medical expertise of the adjudicators, it would be wholly inappropriate if the review panel had to confirm a certificate or issue a new certificate by only considering the matters identified in an application for review, despite the professional opinion of its members that the certificate was incorrect in a different material respect: [1], [7], [29]-[30].
There was no error in the review panel's approach that it should "consider all aspects of the assessment under review": [1], [11], [28], [39].
The procedural Guidelines with respect to review of medical assessment, issued pursuant to s 44(1)(d) of the MAC Act, do not help in understanding the limits of the power of the review panel in s 63: [6], [95].
The provision for referral of an application for review in s 63(2) and (3) of the MAC Act indicates a clear purpose: to notify the review panel of the extent of the dispute which it is being asked to resolve. To effect that purpose, the review panel is restricted to considering the errors identified in the application for review: [65]-[68].
Restricting the review panel to considering only the questions raised by the parties is consistent with the statutory purpose of the MAC Act and structure of Part 3.4: [69], [74]- [77].
Section 63(4) merely confers a power on a review panel allowing it to give effect to whatever conclusion it has reached as a result of the review. If the review panel varies the initial certificate on the basis of a ground raised by one of the parties, reasons would explain that fact and justify the basis for the issue of a new certificate: [63].
The fact that a tribunal is comprised of specialists does not assist in determining the limits of its power to determine disputes: [88]. However, the panel is not required to ignore aspects of an assessment not sought to be reviewed, but which the panel believes to be interconnected: [90]-[91].
The "review" required under s 63, identifiable by reference to specified aspects of assessment said to be incorrect, invites a more restricted construction than the term "review" taken in the abstract might otherwise attract: [64], [78]. SZBEL v Minister for Immigration and Multicultural and Indigenous Affairs [2006] HCA 63; 228 CLR 152; NSW Thoroughbred Racing Board v Waterhouse [2003] NSWCA 55; 56 NSWLR 691; Siddik v WorkCover Authority of New South Wales [2008] NSWCA 116, considered.
Brandy v Human Rights and Equal Opportunity Commission [1995] HCA 10; 183 CLR 245; Colpitts v Australian Telecommunications Commission (1986) 9 FCR 52; Tomko v Palasty (No. 2) [2007] NSWCA 369, referred to.
In reconsidering the impairment to the left knee, the review panel went beyond its statutory jurisdiction because it did not limit itself to considering only the error identified in the application for review: [91], [98].
In relation to issue (ii) (per Giles JA, Allsop P agreeing)
It is not correct to divide a review under s 63 into what the review panel is obliged to review and what it has discretion to review. Instead, the review panel has one task: to review the medical assessment referred to it and either confirm the medical assessor's certificate or revoke it and issue a new certificate. In undertaking this task, the tribunal may exercise their professional judgment about the degree to which they consider certain matters: [1], [38], [39].
The review panel did not exercise their discretion, but exercised their professional judgment, when they gave fresh consideration to the medical assessor's assessment of the left knee injury: [1], [11], [37].
In light of the findings in (i), this issue did not need to be resolved: [96]-[97].
IN THE SUPREME COURT OF NEW SOUTH WALES COURT OF APPEAL CA 40740/07 SC 30038/07
ALLSOP P GILES JA BASTEN JA
14 July 2008 John Charles McKEE v ALLIANZ AUSTRALIA INSURANCE LTD & ORS Judgment 1 ALLSOP P: I have had the considerable advantage of reading the reasons of both Giles JA and Basten JA. I agree with the orders proposed by Giles JA, for the reasons that he has given. I only wish to add the following comments. 2 The resolution of the present question of statutory interpretation is not easy. There is, if I may respectfully say, significant force in the reasons of Basten JA, in particular insofar as his Honour emphasises the roles of the medical assessor and the review panel of medical assessors as parts of a non-curial dispute resolution process. 3 I agree that the secondary material in relation to the legislation is of no particular assistance. 4 The objects of the Motor Accidents Compensation Act 1999 (NSW) (the "MAC Act") set out in s5 of the MAC Act are not apt to be undermined or better promoted by either of the ways of looking at the role and power of the review panel under s63 of the MAC Act that have been the subject of argument in this appeal. 5 The essential consideration is the examination of the text and structure of the MAC Act, in particular Part 3.4, in order to ascertain whether, within that Part, and especially s63, there is a limit on the power of the review panel such that it has no authority to consider any aspect of an injury of the person as it may affect his or her permanent impairment, unless such aspect is encompassed within the expression of the grounds on which the assessment was said to be incorrect contained in, or referable to, the application for review. 6 Whilst there may be sensible policy reasons for limiting the review in that way, I do not extract from the text and structure of Part 3.4, or from s63, any such limitation of power. The limitation of power is not, in terms, provided for in Part 3.4. Thus, one needs to ascertain it necessarily within the text and structure of Part 3.4. Subsections 63(1), (2) and (3) make clear that the application can only be made on the ground that the assessment was incorrect by reference to particulars set out in the application. The word "application" in s63(3) refers to the document or documents that is or are the application. Subsections 63(1) and (2) refer to the process of request that is the application. The notion that there is a limit of power in the review panel requires some clarity in identifying the source of the expression of the limits of the subject of review. There may be one or more documents reflecting the request (that is, the application); there may be oral elaboration of it; there may be amendment of it. There is no necessary clarity in the statute to help identify what is the source of the expression of the limits of the dispute, and so, on this hypothesis, of the limits of the power of the review panel. Guidelines issued under the MAC Act, s44(1)(d) might deal with procedures for the referral of review of assessments or the procedure for assessment, but any such guidelines would not help in understanding the content of the MAC Act, by reference to which the limits of the power of the review panel are to be identified. 7 The text and structure of the MAC Act tends, on the other hand, to support a conclusion that the reach of the review panel's power reflects or mirrors its task. Its task is set out in ss63(1) and (4) - to review the medical assessment and to confirm it, or to revoke it and issue a new certificate as to the matters concerned. The "matters concerned" are the matters referred for assessment, being the medical dispute referred for assessment, being the disagreement between the claimant and insurer about any of (a) to (e) in s58(1), relevantly here (d): "the degree of permanent impairment of the injured person as a result of the injury caused by the motor accident". See generally the inter-relationship between the definition of "medical dispute" in s57, and ss63(4) and (5), 61 and 60(1). The three medical professionals are required to review the medical assessment and come to a professional view about it. If they do not agree with it, they must issue a new certificate as to the degree of permanent impairment. One would not easily constrict the authority of those professionals in a way which would prevent them from considering any aspect of the injured person's condition which in their professional judgment might bear upon that assessment and certificate. 8 No doubt, if their consideration of the matters referred for assessment went beyond the evident dispute thrown up by the claimant and the insurer, procedural fairness would require any and all necessary steps to ensure a fair hearing. Such necessity to provide procedural fairness can be assumed to exist either as part of the common law and as such part of the legal context in which the MAC Act was passed, or to exist interstitially within the MAC Act as an implied condition of the powers of the review panel: Kioa v West (1985) 159 CLR 550 at 582 and 610-611, and thus be a feature that informs the construction and interpretation of these provisions of the MAC Act. 9 In my view, the form or content of the application for review (whether viewed as a document or as a process) does not govern or limit the power or authority of the review panel in the manner contended for by the appellant. 10 GILES JA: The circumstances in which the questions in the application for leave to appeal arise are described in the reasons of Basten JA, which I have had the advantage of reading in draft. I agree that the questions are of importance in relation to the administration of the Motor Accidents Compensation Act 1999 ("the Act"), and that leave to appeal should be granted. 11 For the reasons which follow, in my opinion the review of the medical assessment was not limited to the grounds for incorrectness in a material respect in the application for referral of the medical assessment to the review panel, and there was no failure to exercise a discretion in the review panel issuing the new certificate. Part 3.4 of the Act 12 Part 3.4 of the Act provides for resolution by medical assessment of a "medical dispute", in s 57 defined to mean "a disagreement or issue to which this Part applies". 13 Section 58 sets out the application of the Part - "(1) This Part applies to a disagreement between a claimant and an insurer about any of the following matters: (a) whether the treatment provided or to be provided to the injured person was or is reasonable and necessary in the circumstances,
(b) whether any such treatment relates to the injury caused by the motor accident,
(d) the degree of permanent impairment of the injured person as a result of the injury caused by the motor accident,
(e) the degree of impairment of the earning capacity of the injured person as a result of the injury caused by the motor accident.
(2) This Part also applies to any issue arising about such a matter in proceedings before a court or in connection with the assessment of a claim by a claims assessor." 14 Section 59 provides for the appointment of "medical practitioners and other suitably qualified persons" to be medical assessors for the purposes of the Part. 15 Referral for assessment and (initial) certification by medical assessors are dealt with in ss 60 and 61 - " 60 Medical assessment procedures
(1) A medical dispute may be referred for assessment under this Part by either party to the dispute or by a court or claims assessor.
(2) If the insurer disputes all liability under a claim the dispute cannot be referred for assessment under this Part by the claimant alone.
(3) The request for a referral is to be made to the officer of the Authority designated by the Authority for the purpose (in this Part referred to as the proper officer of the Authority ).
(4) The proper officer of the Authority is to arrange for any such request that is duly made to be referred to one or more medical assessors. 61 Status of medical assessments
(1) The medical assessor or assessors to whom a medical dispute is referred is or are to give a certificate as to the matters referred for assessment.
(2) Any such certificate as to: (a) whether the degree of permanent impairment of the injured person is greater than 10%, or
(b) whether any treatment already provided to the injured person was reasonable and necessary in the circumstances, or
(b1) whether any treatment to be provided to the injured person is reasonable and necessary in the circumstances, or
is conclusive evidence as to the matters certified in any court proceedings or in any assessment by a claims assessor in respect of the claim concerned.
(3) Any such certificate as to any other matter is evidence (but not conclusive evidence) as to the matters certified in any court proceedings or in any assessment by a claims assessor in respect of the claim concerned.
(4) In any court proceedings, the court may (despite anything to the contrary in this section) reject a certificate as to all or any of the matters certified in it, on the grounds of denial of procedural fairness to a party to the proceedings in connection with the issue of the certificate, but only if the court is satisfied that admission of the certificate as to the matter or matters concerned would cause substantial injustice to that party.
(5) If a certificate as to any matter is rejected under subsection (4), the court is to refer that matter again for assessment under this Part and adjourn the proceedings until a further certificate is given and admitted in evidence in the proceedings.
(6) However, if a certificate as to whether or not the degree of permanent impairment of the injured person is greater than 10% is rejected under subsection (4), the court may, if it considers it appropriate, substitute a determination of the court as to the degree of permanent impairment of the injured person (assessed by the court in accordance with section 133) instead of referring that matter again for assessment under this Part.
(7) Except as provided by subsection (6), a court may not substitute its own determination as to any matter referred to in subsection (2) (a), (b), (b1) or (c).
(8) This section: (a) does not prevent a court from referring a matter again for assessment under this Part (as provided for by section 62), and
(b) does not require a court to refer a matter again for assessment under this Part if the matter is not a matter referred to in subsection (2) (a), (b), (b1) or (c).
(9) A certificate is to set out the reasons for any finding by the medical assessor or assessors as to any matter certified in the certificate in respect of which the certificate is conclusive evidence." 16 As envisaged in s 61(7), s 62 provides for further assessment in certain circumstances - " 62 Referral of matter for further medical assessment
(1) A matter referred for assessment under this Part may be referred again on one or more further occasions in accordance with this Part: (a) by any party to the medical dispute, but only on the grounds of the deterioration of the injury or additional relevant information about the injury, or
(2) A certificate as to a matter referred again for assessment prevails over any previous certificate as to the matter to the extent of any inconsistency." 17 Section 63, with which this appeal is principally concerned, provides for review of a medical assessment - " 63 Review of medical assessment by review panel
(1) A party to a medical dispute may apply to the proper officer of the Authority to refer a medical assessment under this Part by a single medical assessor to a review panel of medical assessors for review.
(2) An application for the referral of a medical assessment to a review panel may only be made on the grounds that the assessment was incorrect in a material respect.
(3) The proper officer of the Authority is to arrange for any such application to be referred to a panel of at least 3 medical assessors, but only if the proper officer is satisfied that there is reasonable cause to suspect that the medical assessment was incorrect in a material respect having regard to the particulars set out in the application.
(4) The review panel may confirm the certificate of assessment of the single medical assessor, or revoke that certificate and issue a new certificate as to the matters concerned.
(5) Section 61 applies to any such new certificate."
18 The definitions in s 57 include that "medical assessors review panel means a panel of medical assessors convened under this Part to review an assessment under this Part". Section 63 does not pick up the precise defined phrase, but the intention is clear. The MAA Medical Guidelines ("The Guidelines") next mentioned, which are issued pursuant to s 44 of the Act, provide in para 10.14.1 for convening a review panel consisting of at least three medical assessors to undertake the review. 19 Section 65 provides - " 65 MAA monitoring and oversight
(1) Medical assessments under this Part are subject to relevant provisions of MAA Medical Guidelines relating to the procedures for the referral of disputes for assessment or review of assessments and the procedure for assessment.
(2) The Authority may arrange for the provision of training and information to medical assessors to promote accurate and consistent medical assessments under this Part." The significance of medical assessments 20 While s 60(1) provides that a medical dispute "may" be referred for assessment, referral is commonplace. Proceedings in respect of a motor accident claim may not be commenced unless the claim has been assessed by a claims assessor pursuant to Pt 4.4 of the Act or a certificate of exemption has been issued (s 108). A claims assessor can refer a medical dispute for assessment (s 60(1)), and there is often referral by the parties to a medical dispute or by a claims assessor. Further, there is a threshold degree of permanent impairment before damages for non-economic loss may be awarded (s 131), and if there is dispute about whether the degree of permanent impairment is sufficient for an award the court may not award any such damages unless the degree of permanent impairment has been assessed by a medical assessor under Pt 3.4 (s 132). There is often a practical necessity for medical assessment. 21 Medical assessments are thus an important part of arriving at the claimant's entitlement to damages. Their importance is magnified by their status as conclusive evidence in some respects, including whether the degree of permanent impairment exceeds the threshold, (s 61(2)) and as evidence in other respects (s 61(3)). The court or a claims assessor may refer a matter for further assessment (s 62), but that prospect does not detract from the significance in the ordinary case of a medical assessment. 22 Part 3.4 seeks to provide extra-curial resolution of medical disputes but, recognising the significance of a medical assessment, provides through s 63 that a dissatisfied party can obtain review of the medical assessment of a single medical assessor. Construction of s 63 23 Section 63 only applies when there has been a medical assessment by a single medical assessor; it does not apply if, as ss 60(4) and 61(1) permit, there has been assessment by more than one medical assessor. The occasions for a fresh medical assessment presented by ss 61(4) and (5), s 61(8) and s 62 are limited. The plain purpose of s 63 is that the collegiate professional expertise of three or more medical assessors should be applied in the review, resulting in an assessment which is more likely to be correct and to be accepted by the parties to the medical dispute. 24 A key concept in Pt 3.4 is that of a matter. A medical assessment is an assessment of a medical disagreement about any of the "matters" described in s 58. All the matters are medical in nature; there is possible enlargement so far as the degree of impairment of earning capacity requires knowledge of workplace requirements, but medical professionals frequently express opinions on impairment of earning capacity. The certificate given by a medical assessor is "as to the matters referred for assessment" (s 61(1)). The concept is continued in s 61, and in s 62, with reference both to a "matter certified" and to a "matter referred" and variants on that language. The certificate must set out reasons for the medical assessor's findings "as to any matter certified in the certificate in respect of which the certificate is conclusive evidence" (s 61(8)). 25 Under s 63 the party applying in accordance with s 63(1) applies for referral of the medical assessment, not for referral of part of the medical assessment. Section 63(2) also speaks of referral of a medical assessment, and of grounds that the medical assessment was incorrect in a material respect, not that part of the medical assessment was incorrect. Section 63(4) returns to the key concept, providing that the result of the review panel's review is either confirmation of the certificate of assessment or revocation of the medical assessor's certificate and issue of a new certificate "as to the matters concerned". "The matters concerned" picks up the matters in s 58. It must mean the matters referred for assessment as a whole. The medical assessor's certificate is revoked, s 63(5) provides that s 61 applies to the new certificate, and so the new certificate must entirely replace the medical assessor's certificate. The new certificate must therefore express the review panel's own assessment of the matter or matters referred for assessment. 26 To this point, the review panel has power to carry out whatever assessment is necessary in order to come to its own conclusions upon the matter or matters referred for assessment. Are its powers confined by s 63(2) and (3)? Those provisions implicitly require a statement of grounds of incorrectness in a material respect, which the proper officer can consider in order to be satisfied that there is reasonable cause to suspect that the medical assessment was incorrect in a material respect "having regard to the particulars set out in the application" (s 63(3)). Diverging from the language of s 63(1), which speaks of reference of a medical assessment, the proper officer arranges for "any such application" to be referred to a review panel, that is, the application itself. Does reference of the application carry with it only the grounds of incorrectness in a material respect, and confine the review panel's assessment to that incorrectness? 27 In my opinion, that is not the proper construction of s 63. The referred application is still an application to refer the medical assessment. There is inelegance in referring to the review panel an application to refer a medical assessment to the review panel, but the review panel plainly does more than decide whether it will accede to the application to refer the medical assessment to it. What the review panel receives is a reference to it of the medical assessment. Section 63(2) and (3) do not cut this down. Section 63(3) provides a filter mechanism. Section 63(2) in terms limits the grounds for making an application, although no doubt its effect is that a review panel can not issue a new certificate if it considers that any incorrectness in the medical assessment was not in a material respect, but it does not otherwise affect the performance by the review panel of its task of either confirming the medical assessor's certificate or issuing a new certificate expressing its own assessment of the matter or matters referred for assessment. 28 The review panel is in my opinion not limited to the grounds for incorrectness in a material respect particularised in the application for referral of a medical assessment. There are sound reasons why this construction of s 63 should be preferred to one by which the review panel can not go beyond those grounds. 29 I have described the significance of medical assessments. A medical assessment can have a profound effect on a claimant's recovery, to the perceived detriment of the claimant or the insurer. The legislature has provided for review by a review panel so that a dissatisfied party to a medical dispute can seek redress, as is appropriate given the significance. The dissatisfied party may have particularised the grounds for incorrectness in a material respect, but it would be harsh if the review panel did not have power to entertain altered, added or substituted grounds. (The Guidelines, to which medical assessments are procedurally subject (s 65), provide that application under s 63(1) must be made within thirty days of receipt of the medical assessor's certificate (para 10.1), without ability to extend time (para 10.3)). Ignorance or mistake should not be penalised, and there can be second thoughts; the significance of a medical assessment is such that restrictions on getting it right should not readily be found to have been intended by the legislature. 30 Perhaps of greater significance is the nature of the review panel. The members of a review panel are medical practitioners or other suitably qualified persons. The review panel is to be convened by the proper officer "having regard to the nature of the injury and any continuing disabilities [and] the nature of the dispute" (Guidelines para 10.14.1), underlining that it is to apply the expertise of medical professionals to its review of a medical assessment initially made by a medical professional. The review panel must confirm the certificate of assessment or issue a new certificate replacing it, and as I have earlier explained the new certificate must deal with the matter or matters referred for assessment as a whole and express the appeal panel's assessment of those matters. It would not be a sensible operation of Pt 3.4, and would be at odds with use of the expertise of the medical professionals in extra-curial resolution of medical disputes, that the review panel could not go beyond the particularised incorrectness in a material respect. In particular, it would be wholly inappropriate if the review panel had to confirm a certificate or issue a new certificate despite the professional opinion of its members that the certificate was incorrect in a different material respect. 31 There is a broadly similar scheme for medical assessments in Pt 7 of the Workplace Injury Management and Workers Compensation Act 1998 ("the WIM Act"). In Siddik v WorkCover Authority of New South Wales [2008] NSWCA 116 it was held that in an appeal to an appeal panel against a medical assessment under s 328 of the WIM Act, the appeal panel could consider grounds other than those permitted by the Registrar to proceed under a filter mechanism akin to that in s 63(3) of the Act. The reasons of McColl JA, with whom Mason P agreed, included - "98 Further, while the express limitations on opening the gate to an appeal are suggestive of an appeal limited to the grounds identified by the appellant, there is much to be said for the view that when used in the context of the review of an MAC by a panel including two specialists, that they should be entitled to determine "the true and correct view": Chemler (at [30]). The purpose of setting up a panel with experts is to enable it to resolve questions within its expertise: Kalil v Bray [1977] 1 NSWLR 256 (at 262) per Street CJ (Moffitt P and Glass JA agreeing). 99 Such an approach recognises the importance of the medical assessment in the process of determining an injured worker's rights to, and an employer's obligation to pay, workers' compensation and/or damages. Although the legislature has deliberately separated determination of those issues from the curial decision-maker, it would be a curious to find it intended that the Appeal Panel could not cure an error in a conclusive certificate merely because the parties had not identified it, with the result that a court could be required to determine the parties' rights on the basis of what, in the Appeal Panel's view, was an erroneous MAC. The inclusion of two specialists on the Appeal Panel must have been intended, in part, to permit them to bring their expertise to bear on the contents of the MAC." 32 The language of the WIM Act is different from that of the Act, although the concept of a matter also plays a key part. The analysis of its provisions did not focus on that concept, including in my own reasons, but the view I take of s 63 is consistent with that taken of s 327 and with her Honour's reasons paying regard to the nature of the reviewing tribunal. 33 The reasons of James J discussed at some length remarks concerning review of a medical assessment under the WIM Act in Campbelltown City Council v Vegan [2006] NSWCA 284 and references to those remarks in subsequent decisions. What was said in those cases is now subject to the later decisions in Pitsonis v Registrar of the Workers Compensation Commission [2008] NSWCA 88 and Siddik v WorkCover Authority of New South Wales. His Honour considered that differences between the Act and the WIM Act rendered the remarks inapplicable, and came to his decision essentially because s 63 did not provide that the review panel was to determine whether the medical assessment was incorrect in the material respect of which the proper officer was satisfied and the expression "as to the matters concerned" referred back to the matters in s 58. In my opinion, his Honour came to the correct decision. 34 It should be said that the review panel put the appellant on notice that it would conduct a fresh assessment of the medical dispute, and there was no question of denial of procedural fairness such as arose in Siddik v WorkCover Authority of New South Wales. Failure to exercise a discretion? 35 The review panel's reasons for its findings which accompanied the new certificate include the statement, "The panel noted that all aspects of the assessment under review are to be considered afresh by the review panel". This may have reflected para 10.17.1 of the Guidelines, which as part of a prescription of what a review panel is to do provides that it is to "consider afresh all aspects of the assessment under review". 36 The appellant submitted that, if the review panel was entitled to go beyond the particularised grounds of incorrectness in a material respect, it was nonetheless not obliged to do so; and that the review panel had erred in that it had considered itself obliged to consider afresh all aspects of the medical assessment and had not exercised a discretion in relation to the extent of its review. The appellant said that so far as para 10.17.1 of the Guidelines prescribed that the review panel was to conduct a full fresh assessment it was invalid, because s 63 of the Act did not impose such an obligation and the Guidelines could not affect the review panel's task as found in s 63. 37 It is likely that the review panel had para 10.17.1 of the Guidelines in mind. The immediately following parts of the reasons were concerned with re-examination of the claimant and additional information, topics the subject of paras 10.17.2 and 10.17.3. It does not follow that the review panel erred in failing to exercise a discretion. 38 I do not think it correct to divide a review under s 63 into what the review panel is obliged to review and what it has a discretion to review. The review panel has the one task, to review the medical assessment referred to it and either confirm the medical assessor's certificate or revoke it and issue a new certificate. In the manner earlier explained, the members of the appeal panel bring their expertise to that task, and the confirmation or the new certificate embodies their professional opinion as to the matters referred for assessment in whole. In order to come to its decision to confirm the medical assessor's certificate or revoke it and issue a new certificate the review panel must give consideration to the matters referred for assessment in whole. The consideration as to some aspects of the matters may be brief if there is a discrete particularised incorrectness in a material respect and no other incorrectness in a material respect is apparent to the professional gaze of the members of the review panel, and depending on perceived occasion to go further the review panel may then focus on the particularised incorrectness in a material respect. If that occurs, it is not failure in an obligation or the exercise of a discretion. It is the exercise of professional judgment. 39 There was no error in the review panel's approach that it should "consider afresh all aspects of the assessment under review". Whether the fresh consideration gave cause to question the medical assessor's assessment for incorrectness in relation to the left knee injury was a matter for its professional judgment, and did not involve the exercise of a discretion. The review panel said in its reasons that for the left knee the medical assessor had assessed the 8 per cent whole person impairment on the impermissible basis of arthroscopy findings, and made its own assessment based on x-ray films. The impermissible basis is the kind of incorrectness in a material respect which would have been apparent to the review panel, leading to its reassessment. Orders 40 I propose the orders -
(1) Grant leave to appeal and treat the notice of appeal with appointment filed on 26 October 2007 as being properly filed pursuant to the grant of leave.
(2) Allow the appeal and set aside the judgment below dismissing the summons.
(3) In lieu thereof, order that the certificate issued by the review panel on 28 November 2006 be set aside and the appellant's application for review of the certificate issued on 23 June 2006 be remitted to the Authority for referral to a review panel, to be determined according to law.
(4) Order the respondent to pay the appellant's costs both in the Common Law Division and in this Court. **********
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McKEE
ALLIANZ AUSTRALIA INSURANCE LTD
[1995] HCA 10
(1986) 9 FCR 52
(1985) 159 CLR 550
[2006] HCA 63