1. On 8 September 2025 the worker Mr Peter Thomas (the appellant) lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by Dr Tim Anderson, a Medical Assessor, who issued a Medical Assessment Certificate (MAC) on 11 August 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 availability of additional relevant evidence;
   • the assessment was made on the basis of incorrect criteria, and
   • 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 he 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 did not need to undergo a further medical examination because the Appeal Panel did not find error. Absent a finding of error, the Appeal Panel has no power to require the worker to undergo a re-examination: see New South Wales Police Force v Registrar of the Personal Injury Commission of New South Wales [2013] NSWSC 1792.

1. Without objection by the respondent, the Appeal Panel admits the additional evidence of the ultrasound of the abdominal wall dated 18 August 2025 performed subsequent to the medical assessment.

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. 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:

"The following matters have been referred for assessment (s 319 of the 1998 Act):

• Date of injury: 23/07/19
• Body parts/systems referred: Left upper extremity (wrist)

• Method of assessment: Whole Person Impairment"

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

WPI deductions pursuant to S323 for pre-existing injury, condition or abnormality (expressed as a fraction)

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

Chap 2 P 10

P 467 F 16-28

P 469 F 16-31

Chap 16 P 78

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

1. The worker appealed.
2. The complaints on appeal concerned both the assessment for the left upper extremity (wrist) and the assessment for the digestive system (hernia).
3. In summary, the appellant submitted on appeal that the Medical Assessor made an assessment on the basis of incorrect criteria and/or made demonstrable errors for reasons which included the following in respect of the digestive system (hernia) assessment:
   • failed to make an assessment in accordance with the guidelines;
   • failed to have regard to the extent to which his assessment differed from that of Dr Rapaport;
   • failed to give adequate reasons;
   • failed to explain why he did not assess 3% for each nerve instead of 2%, and
   • his failure to locate an umbilical hernia may be relevant to the assessment.
4. In summary, the appellant submitted on appeal that the Medical Assessor made an assessment on the basis of incorrect criteria and/or made demonstrable errors for reasons which included the following in respect of the left upper extremity (wrist) assessment:
   • there was a potential application of incorrect criteria;
   • failed to give adequate reasons, and
   • failed to explain adequately why his assessment differed from that of

Dr Courtenay and Dr Nair. 5. In summary, the employer Sydney City Council (the respondent) submitted that the Medical Assessor did not make an assessment on the basis of incorrect criteria and did not make demonstrable errors and that the MAC should be confirmed. 6. 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 physical 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. 7. The path of reasoning disclosed by the Medical Assessor must be adequate. This is also dependent on the extent of the history taken and a thorough examination of the appellant so with an adequate record of examination findings so that it can readily be understood by the reader that the correct criteria under the Guidelines have been applied. 8. The Medical Assessor recorded the following history:

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

Mr Thomas related that his occupation in garbage collection necessitated a lot of moving in and out of his garbage vehicle and lifting and moving garbage bins. As a result, it was accepted that he had developed a left sided inguinal hernia, initially in 2017. This was managed by laparoscopic surgery in August 2017. Initially, this gave him a reasonable result, although later there was a recurrence of the hernia which was subsequently managed by an open surgical procedure in October 2019.

Ever since the second surgical procedure, he has experienced altered sensation in the left lower abdominal area extending down over the left side of the scrotum and the inner side of the left leg. Various injection procedures were attempted to try to alleviate this condition but without much success.

He described that he was moving up some steps and stairs in September 2021. Due to the discomfort he was experiencing in his lower abdomen on the left side, he was pulling himself up using the handrail. As he did so, he sustained a wrenching injury to the left wrist complex.

He came under the care of Specialist Orthopaedic Surgeon, Dr John Tawfik who recommended that the wrist condition should be managed conservatively.

He has had a variety of analgesic medication. Most of his medication now is a sedative nocturnal medication. There is no other treatment.

Pain in the left lower abdominal area with reduced sensation which radiates down over the left side of the scrotum and the inner side of the left thigh. Occasionally there is associated swelling. The condition is worse if he is bending, where he experiences a pulsating pain.

When not in use, his left wrist is fairly comfortable. If he tries to use it, it becomes much more painful.

• Details of any previous or subsequent accidents, injuries or condition:

When he was a teenager, there was apparently a fracture to the left wrist, although this healed satisfactorily and, he was able to get back to a physically very arduous occupation for the best part of four decades.

This is fairly reasonable, although attention is drawn to his excess weight and high body mass index.

• Work history including previous work history if relevant:

Initially, Mr Thomas worked in abattoirs. The abattoir where he was working closed down and he then did some cleaning work and lawn cutting. For most of his working life, he has worked for Sydney City Council. Just about all of this has been involved in garbage and waste removal. He was medically retired around 2022. Since then, there has been no further work, nor any further training for work.

Mr Thomas is in a single situation. He is currently living in Housing Commission accommodation. He was living there with his mother until she died about ten years ago. Ever since then, he has been permitted to continue living there.

He is a non-smoker and non-drinker. He is not involved in any physical recreational or remedial activity. He will occasionally watch football on the television with a friend. He has a dog that keeps him company.

He will drive but only for about fifteen minutes. His grass is cut by the council.

He is able to do his own shopping nearby, in lightweight loads."

1. The Medical Assessor had regard to the following special investigations:

1. The Medical Assessor recorded his examination findings as follows:

"Mr Thomas was of average stature with a height of 1.76m. His weight was 120kg. With these parameters, he has a body mass index of over 38. This is excessively overweight and well inside the technical category of 'obese'. The upper level of healthy BMI is 25. In order to achieve this, he should be no more than 77kg. He was in moderate discomfort with his lower left abdominal area.

Upper Limbs. No significant features were identified with the shoulders or the elbows. He had the following wrist movements where the left wrist was rather tender, particularly over the ulnar side.

Abdomen. The abdomen was large and obese. The surgical scars from the previous hernia operations had healed extremely well and were quite difficult to see.

He had pain and reduced sensation over the left lower abdomen. This extended distally over the left lateral side of the scrotum and down over the medial side of the left upper leg.

There was no swelling or identification of any hernia or cough impulse."

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

Mr Thomas gives a history of developing a left sided inguinal hernia around 2017. This was satisfactorily managed by laparoscopic surgery. Unfortunately, there was a recurrence and this necessitated more extensive repair surgery, although this appears to have been fairly satisfactory.

Unfortunately, Mr Thomas is physically very heavy and in September 2021, sustained a wrenching injury to his left wrist complex as he was trying to pull himself up a set of steps using his left hand on the hand rail.

It has been identified that there is an alteration of the normal angulation of the lunate in his left wrist. His clinical management has been conservative. At this assessment, he continues to have moderate dysfunction of the left wrist complex.

Following the surgical procedures for the initial hernia and the subsequent recurrent hernia, Mr Thomas has been left with altered sensation in the ilio-inguinal, ilio-hypogastric and genito-femoral nerves on the left side. This continues to cause him dysfunction and concern.

1. The Medical Assessor set out the facts on which his assessment was based as follows:

"The facts on which I have based my assessment of whole person impairment:

A thorough history, a comprehensive physical examination, a review of the documentation made available by the Personal Injury Commission with reference to the SIRA Guidelines (2021) and AMA-5."

1. The Medical Assessor explained his calculations of his impairment assessment of 8% for the left upper extremity (wrist) and 6% WPI for the digestive system (hernia) as follows:

"Left Upper Extremity. There is an assessable extremity of Mr Thomas's left wrist due to restricted range of movement. No other features were identified.

From Page 439, Table 16-03 this converts to 8% WPI.

Hernia. There is no evidence of any continuing hernia, although Mr Thomas experiences dysfunction of the ilio-hypogastric, ilio-inguinal and genito-femoral nerves. From Page 78, paragraph 16.3, attention is drawn to Page 33, Table 5.1. these three nerves are described in this table with the range of WPI from 0% through to 5%. In

Mr Thomas's circumstances, he experiences sensory loss in an anatomic distribution with mild to moderate neurogenic pain. This places him in the category ranging between 2% and 3% WPI for each nerve. In Mr Thomas's circumstances, 2% for each nerve is assessed as appropriate."

1. The Medical Assessor made brief comments on the other medical opinions, which shows he was clearly cognisant of the IME opinions before him, as follows:

"Specialist Orthopaedic Surgeons, Dr Brett Courtenay and Dr Anil Nair in their reports of 16/04/24 and 23/08/24 respectively, assess 13% WPI for the left wrist. I was unable to replicate these findings. Specialist Surgeon, Dr Adam Rapaport in his report of 17/03/24 assessed 7% for the left wrist complex. My assessment of 8% is close to this.

Dr Rapaport also assessed the hernia and gave a whole person impairment of 15% of the hernia "twice recurrent". I was unable to demonstrate any hernia and the radiological evidence clearly demonstrates that there has been no recurrent hernia. Both Specialist Surgeon, Dr John Garvey in his two reports of 24/12/21 and 30/07/24 and myself have demonstrated dysfunction of the ilio-hypogastric, ilio-inguinal and genito-femoral nerves on the left side. Dr Garvey assessed 1% WPI for each of these nerves. With great respect, I believe 2% per nerve is more appropriate since

Mr Thomas continues to experience a lot of associated features."

1. In respect of the left upper extremity (left wrist) assessment, the appellant complains on appeal that there has been a "potential" application of incorrect criteria by the Medical Assessor and that the Medical Assessor failed to give adequate reasons why his assessment differed from those of Dr Courtenay and Dr Nair. What the Medical Assessor was required to do was make an independent assessment. He was required to apply his clinical expertise to the clinical findings on the day of examination and make an independent assessment in accordance with the correct application of the Guidelines. The MAC must be read as a whole and this is exactly what the Medical Assessor has done here. His examination findings are thorough. He explains that he was unable to replicate on the day of examination the examination findings of Dr Courney and Dr Nair upon which their whole person impairment assessment was based. The Medical Assessor is entitled to rely on his clinical findings on the day of assessment.
2. The appellant complains that Dr Courtenay and Dr Nair used six measurements to get the upper extremity impairment whereas the Medical Assessor uses only four measurements. This is because the Medical Assessor clearly finds in his examination that there was no significant features with the elbows or shoulders. He is entitled to rely on this clinical finding. Drs Courtenay and Nair included findings for the elbow to get to the upper extremity impairment. The Medical Assessor did not because as he records there were no findings of clinical cognisance for the elbow. He has found assessable impairment for the wrist and included the restrictions for flexion, extension, radial deviation and ulnar deviation. The Medical Assessor is entitled to rely on his clinical findings on the day of examination, he has clearly and adequately explained that he wasn't able to replicate the clinical findings of Dr Courtenay and Dr Nair (who included the elbow). Nothing more was required of the Medical Assessor and the Appeal panel can discern no error in the assessment of 8% WPI for the left upper extremity (wrist) which has been correctly assessed in accordance with the criteria in the Guidelines.
3. In respect of the hernia, the appellant complains that the Medical Assessor failed to locate the umbilical hernia and they rely on an ultrasound (subsequent to the medical assessment) dated 18 August 2025 of the abdominal wall has been admitted as additional evidence by the Appeal Panel as it was not objected to by the respondent. The appellant requested a re-examination submitting that the Medical Assessor's failure to locate an umbilical hernia may be relevant to the assessment. However, the findings of the ultrasound are irrelevant. This is because it identifies an umbilical hernia. The hernia as a result of the work injury was an inguinal hernia for which surgery was performed and there has been no recurrence of the inguinal hernia after the last surgery. The findings of the ultrasound dated 18 Augst 2025 are not relevant to the assessment.
4. As to whether there is any error in the assessment for the hernia, the Appeal Panel can discern no such error. The Medical Assessor has taken a through history of an initial inguinal hernia followed by surgical repair and a recurrence which necessitated more surgery. He conducted a thorough physical examination and finds no evidence of a recurrence of the inguinal hernia. The Medical Assessor's clinical examination reveals dysfunction of the ilio-hypogastric, ilio-inguinal and genito-femoral nerves on the left side. He has given an allowance for 2% WPI for the each of these nerves. The appellant complains that the Medical Assessor didn't adequately explain why his assessment of whole person impairment was so different from Dr Rapaport and failed to have regard to the extent to which his assessment differed from that of Dr Rapaport. The MAC must be read as a whole. It is clear that the Medical Assessor is cognisant of Dr Rapaport's opinion as he refers to it. Dr Rapaport's assessment is based on a finding of a recurrent hernia. The Medical Assessor is entitled to rely on his clinical findings on the day of assessment where he states he finds no evidence of a recurrent inguinal hernia. What he does find is dysfunction of the ilio-hypogastric, ilio-inguinal and genito-femoral nerves on the left side and he gives an allowance of 2% each. He explains why his opinion differs from Dr Garvey who also found dysfunction for these three nerves but only assessed 1% WPI for each of these nerves. Dr Rapaport did not assess dysfunction for these three nerves because his assessment is based on a finding of a recurrent hernia. Assessment under the guidelines for these three nerves is a range of 0% to 5%. Using his clinical judgement the Medical Assessor assessed 2% WPI for each nerve. Further explanation of this assessment was not required and the Appeal Panel can discern no error in the assessment which was made correctly in accordance with the Guidelines.
5. For these reasons, the Appeal Panel has determined that the MAC issued on