Background
9 The history of this matter is helpfully summarised in the applicant's outline of submissions filed on 10 February 2020, and I have had regard to that summary in setting out the following background to these proceedings.
10 The applicant was born on 4 October 1964 and previously worked for the Commonwealth as a resident manager for the "Jane Arnold Aboriginal Hostel" in New Farm, Brisbane. She was an "employee" under the SRC Act.
11 On 12 April 2014, the applicant was working at the front desk of the hostel when a patron - who had previously been evicted for being drunk - entered the hostel and yelled at her, threatening to "cut her throat".
12 On 28 May 2014, the applicant made a claim for compensation under the SRC Act in relation to this incident, which was said to be the cause of psychiatric injury to the applicant.
13 In the compensation form lodged on 28 May 2014, the applicant:
Identified the "injury or illness" as "Depression - reactive";
Identified the "Part(s) of the body injured" as "mental state";
Identified the date of injury as 12 April 2014;
Identified the date when the applicant first sought medical treatment for her injury or illness as 28 May 2014; and
Identified the cause of injury as "Resident who had been evicted returned and threatened to cut my throat".
14 On 30 July 2014 Comcare issued a determination accepting liability to pay compensation under s 14 of the SRC Act, which relevantly provides
Compensation for injuries
(1) Subject to this Part, Comcare is liable to pay compensation in accordance with this Act in respect of an injury suffered by an employee if the injury results in death, incapacity for work, or impairment.
…
15 "Injury" is relevantly defined in s 5A of the SRC Act as:
Definition of injury
(1) In this Act:
"injury" means:
(a) a disease suffered by an employee; or
(b) an injury (other than a disease) suffered by an employee, that is a physical or mental injury arising out of, or in the course of, the employee's employment; or
(c) an aggravation of a physical or mental injury (other than a disease) suffered by an employee (whether or not that injury arose out of, or in the course of, the employee's employment), that is an aggravation that arose out of, or in the course of, that employment;
but does not include a disease, injury or aggravation suffered as a result of reasonable administrative action taken in a reasonable manner in respect of the employee's employment.
…
(emphasis added)
16 "Disease" is defined by s 5B (1) of the SRC Act as meaning:
(a) an ailment suffered by an employee; or
(b) an aggravation of such an ailment;
that was contributed to, to a significant degree, by the employee's employment by the Commonwealth or a licensee.
17 In its determination of 30 July 2014, Comcare accepted the applicant's claimed condition as "post-traumatic stress disorder". Relevantly Comcare stated:
…
I have described your claimed condition using the International Classification of Diseases and Injuries. This means the wording of your accepted condition may differ from the wording provided on you Claim for Workers' Compensation form. It is Comcare's policy to link your claimed condition with an internationally accepted medical standard for classifying injuries.
18 Comcare accepted the date of the applicant's injury as 28 May 2014, being the date on which the applicant first sought medical treatment for her condition, and on the basis of medical evidence to the effect that the applicant was suffering from a psychological condition on 28 May 2014 but not before then.
19 When making its decision, Comcare had regard to the following material:
A report dated 26 June 2014 from Dr Chandra, General Practitioner, who diagnosed "Anxiety/Depression".
A report dated 26 June 2014 from Ms Lynette Hand, Psychologist, who diagnosed "Post Traumatic Stress Disorder (309.81), Chronic, according to DSMIV - TR".
A report dated 17 July 2014 from Dr Oelrichs, Psychiatrist, who diagnosed "Posttraumatic stress disorder acute secondary depressive symptoms".
20 The applicant received incapacity payments under s 19 and compensation for medical expenses under s 16 of the SRC Act.
21 Comcare received a number of medical opinions concerning the applicant, including:
Dr Ryan, Consultant Psychiatrist, stating that his "impression" was that the applicant had a "mix of depressive and anxiety symptoms in the context of trauma. Differential diagnoses include post-traumatic stress disorder".
Dr Navin, Occupational Physician, who diagnosed "significant reactive depression".
Dr Shaikh, Consultant Psychiatrist, who diagnosed PTSD.
Dr Oelrichs, Consultant Psychiatrist, who diagnosed PTSD "with co-morbid major depressive condition which is now chronic".
Dr Ryan, Psychiatrist, who stated, relevantly:
I would agree that PTSD would be considered by some psychiatrists to be a differential diagnosis but I think that Ms Mununggurr's presentation would be better conceptualised an adjustment disorder with a mix of depressive and anxious symptomology that occurs in the context of multiple psychosocial stressors, some of which are potentially longstanding with issues of attachment and trauma as discussed above.
22 On 6 June 2016, the applicant lodged a claim for permanent impairment and non-economic loss compensation pursuant to ss 24 and 27 of the SRC Act. Relevantly these sections provide:
24. Compensation for injuries resulting in permanent impairment
(1) Where an injury to an employee results in a permanent impairment, the Commonwealth is liable to pay compensation to the employee in respect of the injury.
(2) For the purpose of determining whether an impairment is permanent, the MRCC shall have regard to:
(a) the duration of the impairment;
(b) the likelihood of improvement in the employee's condition;
(c) whether the employee has undertaken all reasonable rehabilitative treatment for the impairment; and
(d) any other relevant matters.
(3) Subject to this section, the amount of compensation payable to the employee is such amount, as is assessed by the MRCC under subsection (4), being an amount not exceeding the maximum amount at the date of the assessment.
(4) The amount assessed by the MRCC shall be an amount that is the same percentage of the maximum amount as the percentage determined by the MRCC under subsection (5).
(5) The MRCC shall determine the degree of permanent impairment of the employee resulting from an injury under the provisions of the approved Guide.
(6) The degree of permanent impairment shall be expressed as a percentage.
(7) Subject to section 25, if:
(a) the employee has a permanent impairment other than a hearing loss; and
(b) the MRCC determines that the degree of permanent impairment is less than 10%;
an amount of compensation is not payable to the employee under this section.
(7A) Subject to section 25, if:
(a) the employee has a permanent impairment that is a hearing loss; and
(b) the MRCC determines that the binaural hearing loss suffered by the employee is less than 5%;
an amount of compensation is not payable to the employee under this section.
(8) Subsection (7) does not apply to any one or more of the following:
(a) the impairment constituted by the loss, or the loss of the use, of a finger;
(b) the impairment constituted by the loss, or the loss of the use, of a toe;
(c) the impairment constituted by the loss of the sense of taste;
(d) the impairment constituted by the loss of the sense of smell.
(9) For the purposes of this section, the maximum amount is $80,000.
…
27. Compensation for non-economic loss
(1) Where an injury to an employee results in a permanent impairment and compensation is payable in respect of the injury under section 24, the Commonwealth is liable to pay additional compensation in accordance with this section to the employee in respect of that injury for any non-economic loss suffered by the employee as a result of that injury or impairment.
(2) The amount of compensation is an amount assessed by the MRCC under the formula:
($15,000 x A) + ($15,000 x B)
where:
"A" is the percentage finally determined by the MRCC under section 24 to be the degree of permanent impairment of the employee; and
"B" is the percentage determined by the MRCC under the approved Guide to be the degree of non-economic loss suffered by the employee.
(3) This section does not apply in relation to a permanent impairment commencing before 1 December 1988 unless an application for compensation for non-economic loss in relation to that impairment has been made before the date of introduction of the Bill for the Act that inserted this subsection.
23 In her claim form:
The applicant identified the "accepted condition" as "Post Traumatic Stress Disorder".
The applicant identified the "permanent injury/impairment(s) of the body" in respect of which she sought to make a claim as "Psychiatric system".
Dr Ryan, as the applicant's treating practitioner, stated that his preferred diagnosis was: "Adjustment Disorder with depressed & anxious features, chronic (Dr Estensen says PTSD and Depression)".
Dr Ryan described impairment to the applicant as "psychological", and said further:
Have been stable for 6-12 months or more but will improve in the long term.
24 As part of her permanent impairment claim, the applicant relied on a report from psychiatrist Dr Estensen dated 28 May 2016. Dr Estensen diagnosed "Posttraumatic Stress Disorder (chronic) and Major Depressive Episode (moderate severity, treatment resistant). In that report Dr Estensen stated:
Commencing with her being threatened the client had the onset of a range of posttraumatic symptoms including reliving experiences, emotional numbing, cognitive impairment, avoidance behaviour and hypervigilance. The client was unable to return to work and experienced the onset of a depressive illness having the characteristic disturbances of mood, cognitions and neurovegetative function. She has received significant and appropriate treatment but remains symptomatic, with her symptoms causing a reduction of function in many areas of daily living.
25 Dr Estensen assessed the applicant as suffering from a 25% whole person impairment pursuant to table 5.1 of the Comcare Guide to the Assessment of the Degree of Permanent Impairment (edition 2.1).
26 Comcare also received a medical opinion from psychiatrist Dr Lawford who diagnosed "Post Traumatic Stress Disorder" and assessed the applicant as suffering from a 30% whole person impairment.
27 On 1 November 2016 Comcare issued a determination declining liability to pay compensation to the applicant for permanent impairment and non-economic loss under ss 24 and 27 of the SRC Act (1 November 2016 determination).
28 In its 1 November 2016 determination Comcare:
described the "injury" as "adjustment reaction with mixed emotional features";
identified one of the issues for it to consider as being "whether you have a compensable condition";
did not make any express finding about the nature or diagnosis of the applicant's condition; and
concluded that there was a likelihood that the applicant's condition would improve and that therefore permanent impairment compensation was not payable.
29 More specifically, Comcare stated:
In considering if your condition will improve I note:
Dr Ryan supplied a report in regards to a consultation he had with you on the 16 September 2016. Dr Ryan has indicated in his report dated 27 September 2016 that you may have impairment that is not due to your mental disorder. He further stated at the present time he cannot support the notion that you are totally and permanently disabled.
Dr Ryan has also indicated on your Permanent Impairment application dated 17 June 2016 that your condition will improve in the long term. He also commented that you are an intelligent woman with reasonable prognosis however felt that compensation issues needed to be resolved.
Further supporting the likelihood that your condition will improve, Dr Estensen's report dated 21 June 2016 recommended a further 60 psychiatric or psychological appointments over the next 5 years and in response to the treatment to date that it has been extensive and appropriate. Dr Estensen further stated that a biopsychosocial model of treatment has been implemented with some benefit.
Therefore, I determine Comcare is not liable to pay compensation to you for permanent impairment under section 24 of the Safety, Rehabilitation and Compensation Act 1988 (SRC Act). Comcare is also not liable to pay compensation to you for non-economic loss under section 27 of the SRC Act.
It is not necessary for me to consider whether you have an impairment of greater than 10 because I have found you are not suffering from an impairment which is permanent.
30 On 15 November 2016, the applicant sought review of the 1 November 2016 determination in a letter to the Reconsideration Team of Comcare, attaching a copy of the determination and written submissions supporting the applicant's request for reconsideration. The applicant relied also on the reports of Dr Oelrichs, Dr Estensen, and Dr Lawford.
31 On 13 December 2016, Comcare issued a further determination (13 December 2016 determination) affirming its original decision. In the 13 December 2016 determination the Senior Review Officer noted that the applicant refuted the claims that she was engaged by Uber as a driver, or had recently completed creative writing works, and or attended a music festival in Arnhem Land. There was a summary of medical evidence, which stated:
I note that Dr Ryan has been your treating psychiatrist since September 2014 and has provided various medical reports dated 12 December 2014, 2 September 2015, 27 June 2016 and 27 September 2016.
I have reviewed all of the reports, but it is his two most recent reports that are the most relevant to the assessment of permanent impairment before me.
In his report dated 27 June 2016, Dr Ryan stated:
In simple terms, the verbal threat that Ms Mununggurr experienced at work in April 2014 is highly unlikely, in my opinion, to be sufficient to explain the severity and duration of Ms Mununggur's [sic] reported symptoms. Verbal threats whilst no doubt unpleasant and perhaps even amounting to a criminal offence are unfortunate relatively common occurrences in human society and do not usually entail psychological sequelae of an extreme and prolonged kind.
…
In his report of 27 September 2016, Dr Ryan noted the various activities that you had allegedly been involved in over the recent months. These are the ones that your solicitor addressed in recent correspondence to Comcare. Dr Ryan advised that he began the consultation with you on 16 September 2016 with a discussion about these allegations. He reported that you 'down played' the issue of the Uber business saying that you had done 'not much' driving and would never go alone and that you were angry that you had been 'checked on'. Dr Ryan further stated that you denied attending as many social events as Facebook might have indicated.
After discussing the allegations directly with you at consultation, Dr Ryan stated in his report that at the present time he could not support the assertion that you have a degree of permanent impairment and it was also unclear whether any impairment is due to a mental disorder.
…
32 The Senior Review Officer accepted the medical opinion of Dr Ryan in light of the fact that he was the applicant's treating psychiatrist and was the only medical practitioner to have discussed the allegations (namely the Uber driving, completing creative writing works and attending various social events) with the applicant prior to providing his opinion regarding the applicant's psychiatric impairment. The Senior Review Officer continued:
For compensation to be payable, I must be satisfied that your accepted condition has resulted in an impairment that is permanent. On the evidence currently available, I cannot be so satisfied.
The evidence of Dr Ryan casts significant doubt that the incident in May 2014 has resulted in your current psychiatric impairment. Noting that he is your treating psychiatrist, Dr Ryan still went as far as to state that he could not be satisfied that any impairment you currently experience was due to a mental disorder and even if it was, he identified the most significant contributory factor as the protracted medico-legal issue with Comcare. Conditions or impairments caused by the administration of your claim and processes are not compensable.
33 There was no express reference to or determination of the specific condition by the Senior Review Officer.
34 On 15 February 2017, the applicant applied to the Tribunal for review of the 13 December 2016 determination.