1. On 13 December 2024 Nerissa Toong (the appellant) lodged an Application to Appeal Against the Decision of a Medical Assessor. The medical dispute was assessed by Dr Robin Alexander Mitchell (Medical Assessor), who issued Medical Assessment Certificate (MAC) on 2 December 2024.
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 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 appellant suffered an injury on 10 November 2018 to her left upper extremity in her employment with Pegasus Print Group Pty Ltd (the respondent) when she tripped and fell at the respondent's Christmas party.
2. The appellant lodged an Application to Resolve a Dispute in the Personal Injury Commission (Commission) dated 6 September 2024 in which she claimed lump sum compensation in respect of the injury to her left upper extremity.
3. The Medical Assessor examined the appellant on 13 November 2024 and assessed 8% WPI of the left wrist and 0% WPI of the skin /scarring. The total WPI, as a result of the injury on 10 October 2018 was 8%.

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 she be re-examined by a Medical Assessor who is a member of the Appeal Panel. The appellant submits that a re-examination of the appellant is necessary due to the issues identified in the Medical Assessor's examination and the differences and discrepancies identified in the MAC.
3. As a result of that preliminary review, the Appeal Panel determined that there was an error in the MAC and that it was necessary for the appellant to undergo a further medical examination because there was insufficient information upon which to make a determination.

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 Drew Dixon of the Appeal Panel conducted an examination of the appellant worker on 26 May 2025 and reported to the Appeal Panel.

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. The appellant's submissions include the following:

(a) ground 1 - speciality of Medical Assessor - the Medical Assessor erred in his assessment on the basis that the Medical Assessor was not an orthopaedic surgeon, and one that specialises in musculoskeletal injuries. Whilst the appellant acknowledges that the Medical Assessor is a qualified professional and one that is well experienced and qualified in his area of expertise, given the nature of the injuries suffered by the appellant, and the consequent surgery, the appellant ought to have been assessed by an orthopaedic surgeon;

(b) the appellant suffered an injury where she tripped and fell at a Christmas function and land heavily on her left wrist. Following the injuries, the appellant has undergone surgery being an open reduction internal fixation surgery performed by Dr Calvin Chen, orthopaedic surgeon;

(c) ground 2 - sensory loss - the Medical Assessor reports that there was no evidence of sensory loss due to the subject wrist fracture injury and attributed the cause of the left wrist sensory loss to an unrelated injury. By his own admission, the Medical Assessor concedes this is a fresh opinion on causation when he notes: "Associate Prof Courtenay who was silent on that issue";

(d) the cause of the left wrist sensory loss was not in issue with respect to the matter referred to the Medical Assessor. Further, to the extent any previous injury or pre-existing or abnormality was caused by the supposed unrelated injury to the left wrist (which is disputed), the Medical Assessor had to consider the proportion that was unrelated and the extent of that proportion in accordance with section 319(d) of the 1998 Act;

(e) on plain reading of the MAC, the Medical Assessor erred when he failed to properly particularise the proportion of any previous injury and instead delved into an opinion of causation as demonstrated when he opined" "I further note that there was decompressive surgery to the median nerve at the time of the open reduction and internal fixation procedure for the wrist fracture injury, the initial cause of which was unrelated to the wrist injury ";

(f) if the Appeal Panel accepts the Medical Assessor did not err when he ascribed a fresh opinion on causation with respect to the sensory loss to the left wrist, the appellant submits that the Medical Assessor 's opinion is erroneous in any event;

(g) Dr Bodel, in his report of 20 June 2023, reports "grip strength is slightly weak on that left side and there is residual sensory loss". Further, reference is made to the reports of Dr Dowla dated 17 July 2018 and 23 June 2020, report of

Dr Evangeline de Leon dated 27 June 2020 and clinical record of Dr Evangeline de Leon between 25 October 2018 and 17 February 2021. In her statement dated 27 August 2024, the appellant describes at paragraphs 26, 27 and 31 her sensation impairment as a result of the subject injury in comparison to any supposed sensory loss before the injury. The appellant's medical history and findings provide support for the occurrence of sensory loss following the subject injury to the left wrist;

(h) the Medical Assessor erred when he failed to consider the contemporaneous records with respect to occurrence of sensory issues and complaints to the left wrist. Indeed, the Medical Assessor had only opined that "I did not find any evidence of sensory loss due to the subject wrist fracture injury..." without reference to the contemporaneous records except for supposed concurrence with Associate Professor Courtenay, who, the Medical Assessor concedes, was silent on the issue as to attribution of the sensory loss to the subject claim;

(i) if the Medical Assessor properly considered the contemporaneous records prior to the subject date of injury, he would have averted attention to the fact that the appellant suffered nerve related issues to her right wrist;

(j) the Medical Assessor, having properly considered the above, and if correctly assessed the cause of the sensory loss as attributed to the subject injury, should have made a further assessment of 10% upper extremity impairment for a grade IV sensory loss of the median nerve;

(k) ground 3 - range of motion - the Medical Assessor has assessed that there is a total of upper extremity impairment of 13% when utilising Table 16-3 on page 439 of the Guides. The Medical Assessor has provided his calculations on the basis that his assessment demonstrated reduced palmar flexion at 30° (5% upper extremity impairment) compared to the right side of 60° and dorsal flexion, or extension, was possible to 40° (4% upper extremity impairment) compared to 70° on the right. Ulnar and radial deviation were both reduced at 15° (1% upper extremity impairment for the reduction of radial deviation and 3% upper extremity impairment for the ulnar deviation);

(l) preceding this assessment, the Medical Assessor noted the date of injury relating to the assessment was 20 March 2017 as opposed to the correct date of injury being 10 November 2018. The former date of injury pertains to bilateral shoulder and cervical spine injuries, which are not the subject of this claim. Following the incorrect reference to the date of injury, the Medical Assessor has proceeded to provide a comprehensive assessment of the bilateral shoulders notwithstanding the fact the bilateral shoulder condition was not the subject of the assessment. It was only until page 3 of the MAC where the Medical Assessor provides an assessment of the left wrist injury without utilising the standard form as stipulated by the Guidelines;

(m) the Medical Assessor's excursion into an assessment of the bilateral shoulders provided for a relatively incomprehensive assessment of the subject left wrist injury which resulted in a detracted assessment of the subject claim. The reference to the bilateral shoulders and the date of injury that relates to it means the assessment is prone to confusion about where the Medical Assessor's attention was in fact averted to. Further, the Medical Assessor's attention to the bilateral shoulder detracted from an assessment relating to pronation and supination (both assessed by Dr Bodel and Associate Professor Courtenay);

(n) whilst it is acknowledged that an assessment of such impairment pertains to the elbow, the AMA 5 assessment criteria provides on page 472 that: "Impairments of pronation and supination are ascribed to the elbow because the major muscles for this function are inserted about the elbow. This applies even if the loss of forearm rotation results primarily from wrist involvement in the presence of an intact elbow". When considering the medico-legal opinions and the MAC, only the Medical Assessor failed to assess pronation and supination;

(o) when considering the foregoing, the Medical Assessor has erred and/or incorrectly applied criterion when he assessed the impairment arising out of the range of motion impairment caused as a result of the subject injury;

(p) the Medical Assessor erred when he failed to provide his assessment of the subject injury in the standard form as compared to his assessment of the bilateral shoulders, in accordance with Part 2.6 of the Guidelines by reference to Figure 16-1B (page 436) of the AMA 5;

(q) ground 4 - TEMSKI/Scarring - the Medical Assessor failed to consider the extent of impairment caused as a result of scarring. The Medical Assessor observed that "the nature of the scar being a well healed surgical scar from the procedure undertaken is 0%" but ignores the insights from the appellant;

(r) in her statement dated 27 August 2024, the appellant states "I am conscious about scarring on my left wrist. I experience tenderness and the occasional throbbing around the site of my scarring to my left wrist. The throbbing to my left wrist is exacerbated by the colder weather, causing it to be more prominent during winter";

(s) in his medical report dated 28 November 2023, A/Prof Courtenay opines that "...there is some sensitivity in the wrist and touching the scar is irritating";

(t) in accordance with Table 14.1 of the Guidelines, an additional assessment of 1% whole person impairment ought to be allocated where the appellant is conscious of the scar, there is contrast with the surrounding skin, it is locatable, there are minimal trophic changes and staple or suture marks are visible;

(u) had the Medical Assessor properly considered the appellant's statement evidence, he would have opined that an additional 1% whole person impairment ought to be allocated in the matter, and

(v) the MAC ought to be revoked by the Appeal Panel for the reasons outlined above.

1. The respondent's submissions include the following:

(a) speciality of the Medical Assessor- the appellant failed to raise an issue with the Medical Assessor assigned to the matter upon receipt of the Medical Assessment Referral and that it is inappropriate to request a re-examination of the appellant on this basis, at this late stage. Further, the Medical Assessor is a SIRA accredited occupational physician who specialises in musculoskeletal injuries to the lower limb, spine and upper limb. This ground of appeal must fail;

(b) sensory loss - the Medical Assessor provided his opinion that there was no evidence of sensory loss on examination due to the subject wrist fracture. The Medical Assessor referred to the decompressive surgery to the median nerve at the time of the appellant's left wrist surgery, the initial cause of which was unrelated to the wrist injury. This is consistent with the evidence from Associate Professor Courtenay, who in his report dated 28 November 2023, noted that the appellant had a previous carpal tunnel in the wrist which was not work-related;

(c) further, the Medical Assessor is entitled to rely upon his own clinical findings on the day of the examination (Merza v Registrar of the Workers Compensation Commission & Anor [2006] NSWSC 939);

(d) the Medical Assessor's role is to make an independent assessment on the day of examination. He is to rely upon his findings on the day of examination and must make clinical judgements using his clinical expertise. The Medical Assessor appropriately declined to make an assessment of permanent impairment in relation to sensory loss based on his clinical examination;

(e) the Medical Assessor has considered all of the relevant evidence before him, has conducted a thorough examination of the appellant and has provided adequate reasons for his opinion and assessment, which, do not fall into error. The Medical Assessor has reached his own conclusion in his assessment of the appellant, as he was entitled to do so: Stramit Corporation Pty Ltd t/as Stramit Building Products v Holl [2009] NSWWCCMA 32;

(f) date of injury - the appellant seeks to appeal the MAC on the basis that the Medical Assessor recorded an incorrect date of injury on 20 March 2017 on page 1 of the MAC. The Medical Assessor also recorded an incorrect date of injury on 10 October 2018 on page 6 of the MAC. These are examples of obvious errors, pursuant to s129 of the 1998 Act, as the Medical Assessor has otherwise referred to the correct date of injury (10 November 2018) in the remainder of the MAC. The respondent accepts that these obvious errors should be corrected by way of a replacement MAC in accordance with the Personal Injury Commission Practice Direction (PIC7) at Points 73-79;

(g) range of motion - the appellant asserts that the Medical Assessor failed to utilise the standard form as stipulated by the Guidelines when he provided an assessment of the left wrist injury on Page 3 of the MAC. The Guidelines at page 10, Point 2.6, do not require the Medical Assessor to record his findings in the standard form. This does not constitute a demonstrable error and/or incorrect criteria;

(h) failure to assess pronation and supination of the left wrist - AMA 5, Figure 16-1b (pp 437) specifies the methods of assessment of the wrist, including flexion, extension, radial deviation, ulnar deviation and ankylosis. The Medical Assessor was not required to assess pronation and supination, which are methods of assessment for the elbow, and the elbow is not an injury subject to the present proceedings nor the Medical Assessor referral. This does not constitute a demonstrable error and/or incorrect criteria;

(i) scarring - the appellant has not made a valid claim for same in accordance with Apps v Secretary, Department of Communities and Justice [2022] NSWPIC 190. Further, a finding of 0% WPI for the left wrist scarring was open to the Medical Assessor to make, in accordance with Merza;

(j) for the reasons discussed above, the appeal should be dismissed, and the MAC be confirmed, and

(k) in the alternative, the appeal should be dismissed, and the MAC be reissued to correct obvious errors in relation to the date of injury.

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.

1. The appellant submits that the Medical Assessor erred in his assessment on the basis that the Medical Assessor was not an orthopaedic surgeon, and one that specialises in musculoskeletal injuries. The appellant referred to submissions made in respect of the method of examination used by the Medical Assessor in support of this ground of appeal.
2. The Appeal Panel notes that the appellant failed to raise any issue about the Medical Assessor assigned to the matter upon receipt of the Medical Assessment Referral. In such circumstances, it is inappropriate to object to the Medical Assessor on the basis he is not an orthopaedic surgeon following the issue of the MAC. Further, the Medical Assessor is a SIRA accredited occupational physician who specialises in musculoskeletal injuries to the lower limb, spine and upper limb. This ground of appeal is not made out.

1. The appellant submits that the cause of the left wrist sensory loss was not in issue and the Medical Assessor erred when he provided a fresh opinion of causation with respect to sensory loss in the left wrist. Further, the Medical Assessor failed to consider the contemporaneous records with respect to sensory loss and complaints about the left wrist when considering the cause of sensory loss.
2. The Medical Assessor under "History relating to the injury" wrote:

"Ms Toong said that she sustained an injury to the left wrist at an office Christmas party on Saturday 10 November 2018, which time she was not working. She said fell sustaining a fracture of the distal end of the left radius, diagnosed by x-ray

after she was taken to the Blacktown Hospital, which required treatment with open

She had long-standing symptoms of carpal tunnel syndrome in the left hand, and although not apparently work-related the surgeon was able to extend the incision and also carry out a release of the median nerve at the carpal tunnel."

1. In commenting on the other medical opinions at part 10.c of the MAC, the Medical Assessor wrote:

"The legal representative for Ms Toong obtained a medical assessment from Dr James Bodel, and, as detailed in his report of 20 June 2023, he opined a 9% upper extremity impairment for reduced movement in the wrist and a further 10% upper extremity impairment for a grade 4 sensory loss of the median nerve, which combined to 18% upper extremity impairment and therefore an 11% WPI.

The legal representative for the insurance company, Rankin Ellison Lawyers obtained a report from Associate Prof Brett Courtenay dated 28 November 2023, in which he opined that due to the impacted fracture of the left distal radius, that was treated by open reduction and internal fixation, Ms Toong had a permanent impairment of 8% with respect to reduced movement in the left wrist joint with a further 1% WPI for skin scarring, resulting in a total impairment of 9% WPI.

I did not find any evidence of sensory loss due to the subject wrist fracture injury, and nor did Associate Prof Courtenay who was silent on that issue. I further note that there was decompressive surgery to the median nerve at the time of the open reduction and internal fixation procedure for the wrist fracture injury, the initial cause of which was unrelated to the wrist injury.

The nature of the scar being a well healed surgical scar from the procedure undertaken is a 0% WPI, in my opinion."

1. The appellant submits that by his own admission, the Medical Assessor concedes this is a fresh opinion on causation when he notes "Associate Prof Courtenay who was silent on that issue".
2. Associate Professor Courtenay was provided with Dr Bodel's report of 20 June 2023 and requested to provide an assessment of WPI. Associate Professor Courtenay provided an assessment of 8% WPI of the left wrist and 1% WPI for scarring TEMSKI. Associate Professor Courtenay wrote:

"The relationship with the current symptoms are consistent with that history.

The tingling in her wrist and also the restricted movement and loss of grip strength. The more general feeling of numbness down her arm is not related to the wrist. It is related to her shoulder."

1. The Appeal Panel does not consider that Associate Professor Courtenay "was silent on the issue". He clearly expressed the view that any sensory loss was related to the earlier shoulder injury. The question of the cause of sensory loss in the left wrist was in issue between the parties given the difference in opinion expressed in their respective medical reports. The Appeal Panel therefore does not accept the submission that the Medical Assessor provided a fresh opinion on causation.
2. The appellant submits that to the extent any previous injury or pre-existing or abnormality was caused by the supposed unrelated injury to the left wrist, the Medical Assessor had to consider the proportion that was unrelated and the extent of that proportion in accordance with s 319(d) of the 1998 Act. The appellant submits the Medical Assessor erred when he failed to properly particularise the proportion of any previous injury and instead delved into an opinion of causation stating "I further note that there was decompressive surgery to the median nerve at the time of the open reduction and internal fixation procedure for the wrist fracture injury, the initial cause of which was unrelated to the wrist injury".
3. The Appeal Panel is satisfied that the appellant had a pre-existing condition, namely, carpal tunnel syndrome.
4. Paragraphs 1.27 to 1.28 of Guidelines provide:

"1.27 The degree of permanent impairment resulting from pre-existing impairments should not be included in the final calculation of permanent impairment if those impairments are not related to the compensable injury. The assessor needs to take account of all available evidence to calculate the degree of permanent impairment that pre-existed the injury.

1.28 In assessing the degree of permanent impairment resulting from the compensable injury/condition, the assessor is to indicate the degree of impairment due to any previous injury, pre-existing condition or abnormality. This proportion is known as "the deductible proportion' and should be deducted from the degree of permanent impairment determined by the assessor. For the injury being assessed the deduction is 1/10th of the assessed impairment, unless that is at odds with the available evidence."

1. Dr Bodel in his report of 20 June 2023, reports "grip strength is slightly weak on that left side and there is residual sensory loss".
2. Dr Dowla, in a report dated 17 July 2018, notes: "Clinically she had no weakness, wasting or sensory impairment".
3. Dr Dowla, in a report dated 23 June 2020, notes "there is residual left median nerve slowing" and "there is reasonably electro-clinical correlation for carpel tunnel syndrome on the right".
4. Dr Evangeline de Leon, general practitioner, in a report dated 27 June 2020, reports "Nerissa complained of intermittent numbness of her right hand after prolonged repetitive work since 11/09/2019".
5. The clinical records of Dr Evangeline de Leon contain the following entries:

(a) 1 June 2018 records "...pain, numbness of middle 3 fingers few weeks+ numbness of L arm after working at end of a shift...feels some numbness - arm";

(b) 22 June 2018 records "claims that when working at waist level L hand becomes numb better with hanging down + noted on waking up - Pt to have nerve conduction study. Refer to Dr Dowla";

(c) 29 June 2018 records: "Pt claims numbness of arms if arms above waist- improve hands down";

(d) 13 July 2018 records: "Patient claims L shoulder is noted to pain on ...during the day since May 2018 but she tends to ignore it. But pain is worse at night since R shoulder is getting better. The pain accompanies the numbness of whole arm. When pressed the upper arm ...numbness is felt on her hand";

(e) 25 July 2018 records: "Discuss letter from Dr Dowla re CTS both hands";

(f) 27 July 2018 records: "New W C claim re L shoulder + bilateral carpal tunnel syndrome";

(g) 25 October 2018 records "on + off numbness of both hands ...while at work holding books + counting papers, cards, aggravated by sudden jerking motion - pain is also felt - the whole arm - numbness is noted almost always at night while in bed and if she accidently lies on her side";

(h) 19 November 2018 records "DOI 10/11/19 fall L wrist during work at Christmas party had L distal radius facture";

(i) 7 December 2018 records "L wrist wound healed... feel numbness radiating to forearm up to upper arm";

(j) 7 January 2019 records restrictions to the left wrist;

(k) 25 January 2019 records "L hand [increased] sensitivity to touch 1st and 2nd fingers, 3rd to 5th fingers feel tight, unable to grip fully";

(l) 11 March 2019 records "L hand feels swollen";

(m) 29 March 2019 records "L hand... feel numb along thumb";

(n) 23 April 2019 records "L[eft] wrist feels numb occ + fingers swollen";

(o) 22 May 2019 records " L hand pain after work ...but feels swollen in morning. pt [sic]...droppings things c L hand...continue physio]";

(p) 17 July 2019 records "Left wrist occ [sic] throbbing pain .... + unable to lift bec [sic] hand feels funny + she drop [sic] things. Any lifting is done with both hands ";

(q) 11 September 2019 records:" numbness L hand after prolonged repetitive work";

(r) 19 October 2020 records "occ weakness L[eft] hand + drop things if she's not concentrating Pt (sic) feels L[eft] hand is weak when exercising c dumbbell ... but patient is afraid to have metal removed as per Dr Smith's suggestion", and

(s) 17 February 2021 records "lack of strength L[eft] hand resulting to dropping plates while washing or dropping pots/pans when cooking".

1. In her statement dated 27 August 2024, the appellant describes her sensation impairment following the subject injury:

"26. As a result of my left wrist injury, my left-hand grip has decreased dramatically. I unable (sic) to properly grip and hold items in my left-hand, causing me to drop and break items on numerous occasions both at home and at work.

1. I am unable to hold items in my left-hand for long periods without feeling pain and a sensitive and tingling sensation to my left wrist.
2. I experience a constant tingly sensation and numbness to my left index finger, thumb and wrist. The sensation worsens when I am sleeping."
3. The appellant submits that if the Medical Assessor properly considered the contemporaneous records prior to the subject date of injury, he would have averted attention to the fact that the appellant suffered nerve related issues to her right wrist. The appellant submits that the Medical Assessor, having properly considered the above and if correctly assessed the cause of the sensory loss as attributed to the subject injury, should have made a further assessment of 10% upper extremity impairment for a grade IV sensory loss of the median nerve.
4. The Appeal Panel considered that the reasoning process was not adequately made out by the Medical Assessor in terms of his finding that there was no evidence of sensory loss due to the subject wrist fracture injury. The Medical Assessor failed to take into account the clinical notes of Dr de Leon and the appellant's statement or adequately document the sensory changes. This ground of appeal is made out.
5. The Appeal Panel accept that the nerve conduction study performed pre-injury demonstrated that the appellant had pre-existing CTS which was worse in the left hand. However, the Appeal Panel is satisfied that it is not unusual to get symptoms post-surgery where a volar plate is inserted and such surgery often includes a carpal tunnel release. The Appeal Panel does note that even with a carpal tunnel release there can be post-surgical swelling around the wrist, as noted in Dr de Leon's clinical notes, and this can cause issues including residual sensory changes.
6. The Appeal Panel was satisfied that the appellant developed sensory changes likely due to surgery to her left wrist following the fall on 10 November 2018.

1. The appellant submits the Medical Assessor has erred and/or incorrectly applied criterion when he assessed the impairment arising out of the range of motion impairment caused as a result of the subject injury. The Medical Assessor erred when he failed to provide his assessment of the subject injury in the standard form as compared to his assessment of the bilateral shoulders, in accordance with Part 2.6 of the Guidelines by reference to Figure 16-1B (page 436) of the AMA 5.
2. The Appeal Panel accept that the Medical Assessor did not document his findings on a standard form as recommended in Part 2.6 of the Guidelines. However, this is not a mandatory requirement, and it is possible for a Medical Assessor to provide all the necessary findings in the body of the MAC. The Appeal Panel does not regard the failure to use the standard form as set out in Part 2.6 of the Guidelines as a demonstrable error or the incorrect application of the criteria.
3. The Medical Assessor has assessed that there is a total of upper extremity impairment of 13% when utilising Table 16-3 on page 439 of the Guides. The Medical Assessor has provided his calculations on the basis that his assessment demonstrated reduced palmar flexion at 30° (5% upper extremity impairment) compared to the right side of 60° and dorsal flexion, or extension, was possible to 40° (4% upper extremity impairment) compared to 70° on the right. Ulnar and radial deviation were both reduced at 15° (1% upper extremity impairment for the reduction of radial deviation and 3% upper extremity impairment for the ulnar deviation).
4. The appellant argues that the Medical Assessor's excursion into an assessment of the bilateral shoulders provided for a relatively incomprehensive assessment of the subject left wrist injury which detracted from the assessment of the subject claim. The reference to the bilateral shoulders and the date of injury that relates to it means the assessment is prone to confusion.
5. The Appeal Panel rejects these submissions concerning the assessment of the bilateral shoulders as the appellant has failed to establish that this resulted in any material error.
6. The appellant submits that the Medical Assessor's attention to the bilateral shoulder detracted from an assessment relating to pronation and supination. The Appeal Panel notes that both Dr Bodel and Associate Professor Courtenay assessed pronation and supination.
7. The Appeal Panel acknowledges that an assessment of such impairment pertains to the elbow, however, the AMA 5 provides on page 472 that: "Impairments of pronation and supination are ascribed to the elbow because the major muscles for this function are inserted about the elbow. This applies even if the loss of forearm rotation results primarily from wrist involvement] in the presence of an intact elbow".
8. The Appeal Panel consider that the Medical Assessor should have measured pronation and supination when assessing the impairment of the wrist, even though this is taken into account in assessment of elbow. If a volar plate and screws are inserted, as in this case, rotation of the wrist can be limited and an additional amount may be assessed. The Appeal Panel considered that the reasoning process was not adequately made out by the Medical Assessor in terms of his failure to measure pronation and supination. This ground of appeal is made out.

1. The appellant submits the Medical Assessor failed to consider the extent of impairment caused as a result of the TEMSKI/Scarring. The appellant argues that the observation of the Medical Assessor that "the nature of the scar being a well healed surgical scar from the procedure undertaken is 0%" ignores the evidence of the appellant.
2. In her statement dated 27 August 2024, the appellant states "I am conscious about scarring on my left wrist. I experience tenderness and the occasional throbbing around the site of my scarring to my left wrist. The throbbing to my left wrist is exacerbated by the colder weather, causing it to be more prominent during winter".
3. In his medical report dated 28 November 2023, A/Prof Courtenay assessed 1% WPI for "Scar TEMSKI". He wrote:

There is a well healed scar over the volar aspect of that left wrist. It is barely visible but there is some sensitivity in the wrist and touching the scar is irritating."

1. Dr Bodel did not refer to scarring or make any assessment in respect of scars.
2. In accordance with Table 14.1 of the Guidelines, an additional assessment of 1% whole person impairment ought to be allocated where the appellant is conscious of the scar, there is contrast with the surrounding skin, it is locatable, there are minimal trophic changes and staple or suture marks are visible.
3. The appellant submits that had the Medical Assessor properly considered the appellant's statement evidence, he would have assessed an additional 1% WPI.
4. The Appeal Panel accepts the Medical Assessor did not take into account the fact that the appellant is conscious of the scar, has some tenderness and occasional throbbing around the scar. The Medical Assessor did not consider whether this was an "uncomplicated scar" or whether TEMSKI should be applied. In the opinion of the Appeal Panel, making an observation that there was a well healed surgical scar did not amount to a proper consideration of whether an assessment should be made in respect of the scar. This ground of appeal is made out.
5. The Appeal Panel, having found error, concludes that it is necessary for the appellant to undergo a further medical examination because there is insufficient evidence on which to make a determination in respect of the sensory change and scarring.
6. As noted above, Medical Assessor Drew Dixon of the Appeal panel examined the appellant on 26 May 2025. Medical Assessor Dixon provided the following report:

This 61 year old claimant sustained an injury to her left wrist at 9.45 pm on 10 November 2018 while she was dancing with a work colleague at a Christmas work party and was accidentally kicked by another work colleague. She became unbalanced and fell onto her buttocks and her outstretched left hand and sustained a fracture of her left wrist. She was taken to Blacktown Hospital and ORIF was performed with a volar plate and screws. She was in a splint for six weeks after the operation and then had physiotherapy for six months. She required analgesia and anti-inflammatory in the convalescent period.

At the time of the accident she worked for Pegasus Print Group as a process worker and although she attempted to return to work, she had difficulty with repetitive folding, packing and taping of materials and more recently, has accepted a job as a pharmacy assistant, which she commenced two weeks ago. This does not involve any heavy lifting or excessive repetitive tasks and she is enjoying the work.

Her current work restrictions are 3kg lifting limit above chest height.

She lives in the family home, for which she is paying a mortgage. She is a single mum with two adult children. She does have difficulty with heavy household cleaning chores as well as repetitive tasks such as meal preparation, cooking, washing up and ironing and difficulty lifting heavy groceries and laundry.

She has difficulty with repetitive tasks such as ironing, bed making and cleaning the car and doing the garden. She has difficulty with prolonged driving and has difficulty returning to recreational dancing such as rock and roll. She reports difficulty holding a cup at times and picking up fine objects such as needles and pins.

She reports residual pain and stiffness in her left wrist with difficulty with her ADLs as noted above. She reports residual paraesthesia extending to the thumb, index and middle finger of her left hand. She reports the volar scar is very tender, particularly distally and painful if bumped, impacting on her ADLs. She is able to readily localise the scar and remains conscious of it. She continues her own hand exercises and uses a sponge ball. She feels that she does not have sustained grasp and as noted above, drops objects at times around the house.

On examination on 26 May 2025 she was 5 foot tall and weighed 60 kg.

There was stiffness of her left wrist with dorsi flexion 40 degrees, palmar flexion 30 degrees, radial deviation 15 degrees and ulnar deviation 35 degrees. Grip strength was grade 4 out of 5, thenar power was grade 5 out of 5 as was intrinsic power in her left hand. There was grade 4 out of 5 sensory change in her left thumb, index and middle fingers and clinically, there is a scar neuroma at the distal scar involving the recurrent branch of the median nerve. Percussion of this area causes paraesthesia over the thenar eminence. The volar scar is 5cm long and shows hypertrophic change and colour contrast and is very tender if percussed, especially distally and this impacts on her ADLs. She is able to readily localise the scar which is visible with a short sleeve top.

She reports pain and stiffness in both shoulders which were the subject of another claim with that on the right requiring rotator cuff repair on two occasions and on the left, rotator cuff repair on one occasion. There was 2cm of wasting of her left forearm measuring 20cm on the left and 22 cm on the right, 10cm below the elbow crease and both upper arms, 10cm above the elbow crease, measured 26cm.

X-ray of her left wrist on 11 November 2018 showed an impaction fracture of the distal radius with the fracture line extending into the articular surface. There was slight widening of the radio scaphoid joint.

Fluoroscopy on 15 November 2018 showed images with good alignment with respect to ORIF of the right radial fracture.

Nerve conduction studies on 17 July 2018 and re-done on 28 July 2020 showed right median nerve sensory slowing at the wrist, typical of carpal tunnel syndrome. The changes are mild and there is residual left median nerve slowing, which is sensory, not motor.

A treatment report of Professor Smith confirmed his assessment of the left wrist and right wrist and that the claimant had undergone bilateral carpal tunnel release with a good outcome of the right hand and persisting symptoms on the left.

There was annotation by Associate Professor Brett Courtenay that the claimant had had previous surgery to her right shoulder in 2017 and had consequential supraspinatus tear of her left shoulder where she had rotator cuff repair on 29 January 2019 by Dr Daniel Biggs.

That for the post traumatic stiffness of her right wrist is from Pie Chart 16-28, 16-31 and 16-37 (pronation and supination), Pages 467-474, AMA V, 10% upper extremity impairment.

That for the sensory change grade 4 out of 5 of the median nerve is from Table 16-15, Page 392, one-fifth of 39%, giving 8% upper extremity impairment.

This gives a total from the Combined Values Chart of 18% upper extremity impairment which equates to 11% whole person impairment.'

That for her tender scar at the left wrist as described is from Table 14.1, Page 74 of the WorkCover Guidelines, 1% whole person impairment.

This gives a total of 12% whole person impairment. This is consistent with the findings of Dr Bodel.

Associate Professor Brett Courtenay was silent on sensory loss. His findings for impairment for reduced movement were approximate to those found today. He gave assessment for the scarring of 1% WPI with which I concur.

The PIC Assessor, Dr Robin Mitchell, found a slightly more restricted range of motion of the left wrist than was found today and it should be noted there was 0% UEI for pronation and supination. He felt there was no residual sensory loss but did give 1% WPI for the scarring at the left wrist, with which I concur."

1. The Appeal Panel adopts the report and findings of Medical Assessor Dixon.
2. The Appeal Panel assessed 10% upper extremity impairment for loss of range of motion in the left wrist and 8% upper extremity impairment for sensory change. This gives a total from the Combined Values Chart of 18% upper extremity impairment which equates to 11% whole person impairment.
3. The Appeal Panel therefore assesses 11% WPI in respect of left upper extremity and 1% WPI for scarring. This results in a combined total of 12% WPI.
4. For these reasons, the Appeal Panel has determined that the MAC issued on

2 December 2024 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 Robin Alexander Mitchell 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)

Table 16-15, Page 392

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