What happened: A NSW appeal panel revoked a medical certificate after finding the assessor dismissed an injured worker's back and hip complaints with generic remarks about homelessness rather than engaging with decades of medical evidence.
Who's involved: Keegan Investments (trading as Bakers Delight) as the employer; the NSW Personal Injury Commission Medical Appeal Panel.
What's at stake: The worker's permanent impairment assessment for his back and left hip, originally rated at 0% and raised by the appeal panel to 10% each (9% after statutory deductions for pre-existing conditions).
Why it matters: Medical assessors cannot substitute generic commentary about a claimant's social circumstances for engagement with the specific clinical evidence - a principle with direct implications for how insurers and injury managers handle pre-existing condition arguments.
Where it stands: The appeal panel revoked the original certificate and issued a new one on October 2, 2026.
Twenty-six years of limping, and the medical assessor wanted to talk about homelessness.
That is the core of a NSW Personal Injury Commission appeal panel decision that revoked a workers' compensation medical assessment certificate and replaced it with one significantly more favourable to the injured worker. The case, decided on October 2, 2026, turned on what the panel found was a failure to do the basic work: examine the worker properly and explain the reasoning behind the assessment.
The worker was a head baker at a Bakers Delight franchise. In May 2000, a stack of baking tins slid across the floor and struck his right foot and ankle. Six tins, each weighing roughly four kilograms.
He never went back to baking.
What followed was more than two decades of medical assessments, disputes, and a slow physical decline. The worker's right ankle injury was accepted and assessed at 10% permanent loss of efficient use of the right leg below the knee - a figure confirmed on two separate occasions, in 2003 and 2006, and upheld on appeal. Over time, he developed back pain and left hip pain, which he attributed to years of compensating for the ankle injury - walking with a limp, falling.
By the time the dispute reached the Personal Injury Commission in 2025, the worker was claiming permanent impairment of his back and left hip as consequential conditions of the original ankle injury.
The matter was referred to a medical assessor, who examined the worker in November 2025 and issued a certificate in January 2026. The result: 0% impairment for the back, 0% for the left hip, and 10% for the right ankle - the same ankle figure that had stood since 2003.
The worker appealed on two grounds. The appeal panel agreed with both.
On the right ankle, the panel found the assessor's examination was too thin to support any conclusion. Where a prior assessor had recorded detailed observations across two examinations - whether the worker could walk on heels and toes, whether there was swelling, tenderness to touch, discomfort on movement, loss of power, and changes in sensation - the January 2026 certificate noted little more than that the worker walked slowly with a walker, his right ankle did not move or flex, and his right calf was slightly larger than his left.
The panel accepted that this type of assessment does not require formal range-of-motion measurement. But the assessor still had to show how he reached his conclusion. The gap between what the prior assessor recorded and what this assessor recorded was, in the panel's view, too wide. The lack of detail meant it was impossible to tell whether the assessor had identified all the relevant symptoms and restrictions before applying his clinical judgment.
The panel found this amounted to a demonstrable error.
The second ground cut deeper. The assessor had found 0% impairment for both the back and left hip, attributing the worker's conditions entirely to degenerative and developmental changes worsened by what the certificate called "constitutional and lifestyle features." The certificate included a paragraph about the health consequences of prolonged homelessness - increased chronic illness, mental illness, substance use, cognitive decline - and concluded that "these social issues appear to better explain his multiple current complaints."
The appeal panel found this was not reasoning. It was commentary.
The assessor did not engage with when the worker became homeless, for how long, whether his back and hip symptoms started before or after, or the documented history of falls attributed to the ankle injury. He did not address the fact that observations of the worker limping had been recorded for more than 20 years. He did not explain why homelessness was a better explanation than two decades of altered gait. He simply stated it.
The panel found this too amounted to a demonstrable error. Having identified pre-existing conditions (a degenerative lumbar spine and developmental hip dysplasia), the assessor was required to assess the impairment and then apply any statutory deduction for those pre-existing conditions - not attribute all of it to lifestyle factors without explaining why.
The appeal panel ordered a fresh examination, conducted by one of its own assessors in June 2026. That examination found measurable losses: limited right ankle motion, reduced range of motion in the lower back with muscle guarding, and a slight loss of hip motion with pain on internal rotation.
The new certificate assessed 10% permanent impairment of the back and 10% permanent loss of efficient use of the left leg at or above the knee. Both were subject to a one-tenth statutory deduction for pre-existing conditions, yielding 9% each after the deduction. The right ankle remained at 10% with no deduction.
The panel noted that the modest one-tenth deduction was appropriate given that the injury occurred more than 26 years ago and observations of limping had been recorded continuously for over 20 years.
Claims and injury management professionals dealing with long-tail workers' compensation matters will recognise the lesson: pre-existing condition arguments require specific engagement with the claimant's actual medical timeline, not generic observations about their social circumstances.
The determination was handed down by the Medical Appeal Panel of the NSW Personal Injury Commission. None of the findings have been the subject of further appeal as at the date of the decision reviewed.
