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Accident Compensation Cases

Penney v Accident Compensation Corporation (DC, 25/01/12)

Judgment Text

RESERVED JUDGEMENT OF JUDGE M J BEATTIE 
M J Beattie Judge
[1]
The issue in this appeal arises from the respondent's decision of 23 February 2009, whereby it had determined that the appellant had attained Vocational Independence within the meaning of the Act in respect of seven work-types. 
[2]
It is the case that the review decision, which was the prelude to this appeal, modified the respondent's primary decision by deleting one of the work-types, and it is therefore the case for the purposes of this appeal, that the appellant was found to have vocational independence in respect of the following six work-types. 
“Production Clerk 
Stock Clerk 
Cafe and Restaurant Manager 
Hotel or Motel Manager 
Cost Clerk 
Inquiry Clerk ”
[4]
The background facts relevant to the issue in this appeal may be stated as follows: 
The appellant then aged 44 years was a sub-contracting builder by occupation and had been for some 10 years, when on 16 February 2004 he fell off some scaffolding in the course of his employment and fell approximately 4 metres to the ground, landing on his back. 
The appellant experienced pain in the lumbosacral region as well as in the thoracic area of his spine, and he also suffered pain in his left elbow. 
It is the case that while the appellant began to experience significant pain in his back and elbow, x-rays taken shortly after the accident did not identify any physical damage to his back or elbow. 
In May 2004 the appellant was referred to Mr Brian Otto, Orthopaedic Surgeon, by his GP, and Mr Otto summarised the appellant's physical condition as follows: 
“ … In summary and after reviewing his x-rays, Richard to me looks to be within normal limits apart from a rather small sized D7 vertebra, the discs are well maintained in height and the appearances are within normal limits adjusting for the mild thoracic scoliosis. 
I feel that Richard has mainly had soft tissue changes with perhaps extension producing facetal discomfort in the thoracic and lumbar spine in particular. … I think he has been very lucky not to have had additional damage from the fall that he described, but certainly the soft tissue component and the extension, with the potential tp produce damage to the articular facets in the lumbar and thoracic spine is enough to make him very wary of going back to lifting and expose himself to the heavy physical aspects of building at this time. 
… ”
The appellant was accepted as being incapacitated, principally because of the pain that he was experiencing in his back. 
From mid-2004, through to early 2008, the appellant was involved in various activity based programmes and work trials, and also underwent a number of medical assessments. 
In June 2004, June 2005 and February 2007 the appellant underwent Initial Medical Assessments and certainly in the February 2007 Assessment a number of work-types were identified as being medically sustainable. 
The appellant underwent further work trials in 2008 and in the latter part of 2008 he completed a Functional Reactivation Programme and this was the last activity noted on his Individual Rehabilitation Plan. 
In February 2009 the appellant underwent a Vocational Independence Occupational Assessment with a Mr G Birchfield, and his assessment identified 20 work-types as being occupationally suitable for the appellant. 
On 10 February 2009 Mr lain Kelman, Orthopaedic Surgeon, carried out a Vocational Independence Medical Assessment and he identified the appellant as having the physical ability to work in the six work-types set out above, plus the work-type of a Barista. 
Consequent upon Mr Kelman's report, the respondent issued its decision on 23 February 2009 determining that the appellant had attained vocational independence in respect of the seven work-types identified by Mr Kelman. 
The appellant sought a review of that decision and it is the case that the appellant, who represented himself at the review, did not introduce any evidence in opposition to the reports of the two Vocational Independence Assessors. 
In his decision dated 31 August 2009 the Reviewer, Mr Orange, identified that there was no evidence that could identify that the assessments were incorrect, and he confirmed the respondent's primary decision that the appellant had attained vocational independence. The only variation made by the Reviewer was to rule out the work-type of Barista, not because the appellant was not occupationally or medically capable of engaging in that work-type, but simply because the Reviewer considered that the salary that such a work-type would provide was not compatible with the appellant's pre-injury earnings. 
For the purposes of the appeal to this Court and with the appellant now represented by counsel, independent occupational and medical independence reports have been introduced from a Ms Christine Nolan, and Dr Tony Chew, respectively. Counsel for the Respondent has also introduced reports from Mr Birchfield and Mr Kelman in response thereto. 
[4]
It should be identified that the appellant did not suffer any broken bones in the fall and an MRI scan taken in mid-2005 identified that the appellant's back showed no major abnormalities and no major disc prolapse or root impingement. That was the advice given by Mr Kim Hirnar, Orthopaedic Surgeon, who had sought the MRI scan. A subsequent comment from Dr Paul Quinn in September 2006, relating to that MRI scan stated that it showed a small L5/S1 prolapsed intervertebral disc with a central annular tear. That assessment was later commented on by Mr Kelman who stated that there was an annular tear at the T7 level in the appellant's thoracic spine. 
[5]
The appellant underwent an Initial Vocational Independence Occupational Assessment by Carolyn Field of SB Consultants in July 2007, and in her assessment she identified four of the work-types ultimately forming part of the vocational independence decision as being occupationally suitable for the appellant, those four work-types being Production Clerk, Stock Clerk, Cafe or Restaurant Manager, and Hotel/Motel Manager. 
[6]
The Vocational Independence Medical Assessment associated with that Occupational Assessment was undertaken by Dr Bruce Gollop, Occupational Medicine Specialist, and he stated, inter alia, as follows: 
“ … His overall condition has been stable and he has been working up to 25 hours a week until 2 months ago when, for no apparent reason, he had a setback. I would be confident that he would be able to improve over the next 2-3 months with his current daily exercises, to the point where he should be able to initially return to 20-25 hours a week. After that point, he should be able to increase his hours as his condition allows. 
The diagnosis is of mechanical back pain located to the thoracolumbar junction and no further formal rehabilitation, other than his current exercise programme and analgesics, would be indicated. Given his setback over the last 2 months, he is not currently fit to work 35 hours a week but he is fit to work up to 25 hours a week in light supervisory type work, where he is not twisting his thoracic spine. He is permanently unfit to work as a builder or for those occupations where he is carrying out repetitive lifting of more than 10 kg or required to rotate his thoracic spine. He should be reviewed in 6 months time, after he has been working 20-30 hours a week in his cafe. …  ”
[7]
In respect of the relevant work-types as identified by Ms Field, Dr Gollop indicated that the appellant was fit for up to 25 hours per week at those work-types, and that his situation should be reviewed in six months' time. 
[8]
It is the case that the appellant did become engaged in further rehabilitation assistance programmes and this then led on to the final Vocational Independence Assessments in February 2009. 
[9]
Mr G Birchfield of Clear Consulting was instructed by the respondent to carry out a Vocational Independence Occupational Assessment, and he did so on 2 February 2009. The Court can take judicial notice of the fact that his assessment is both extensive and thorough and occupies 22 foolscap pages. The Court is only concerned with the work-types which were ultimately determined as being physically sustainable and in respect of each of the six work-types, Mr Birchfield has given in-depth reasoning as to why he considers that these work-types are occupationally suitable for the appellant. 
[10]
I do not propose to set out the various reasoning given by Mr Birchfield for his assessments, save for saying that after identifying the requirements of the work-type and identifying the appellant's abilities in respect thereof, Mr Birchfield has stated on each occasion that the appellant has the relevant experience and skills for the particular work-type in question, and that there was no vocational reason why he could not take up such a position. 
[11]
As earlier identified, Counsel for the Appellant introduced an Occupational Assessment from Christine Nolan, describing herself as being engaged in Career Counselling and Consultation. Although Ms Nolan was aware that she was not required to comment on the appellant's medical condition and any restrictions that it may give rise to, she elected to do so, and she made comment on those physical aspects in relation to each of the work-types in issue. Insofar as the occupational suitability of the work-types are concerned, she noted inter alia as follows in respect of each work-type: 
1.
Production Clerk 
“Taking Mr Penney's skills, training, experience and qualifications for this work type, the 2009 VIOA relies on skills and experience he has, mainly from his work in self employment as an amplifier manufacturer and builder. The skills include processing orders, maintaining records and planning resources received. He would also have administrative skills from his work trial in his hotel business. He has had some computer training, and while he has no formal qualifications, his previous experience means that an entry level position could be considered, and as such, the ACC work type detail sheet is correct. 
However it is apparent from a search of job websites that there are few advertised entry level positions, and that most of the advertised positions call for clerical and computer ability greater than Mr Penney would appear to have …  ”
2.
Stock Clerk 
“Taking Mr Penney's previous work experience, the 2009 VIOA relies on his reported skills in monitoring stock levels and maintaining records in his amplifier manufacturing business, his organisational and communication skills. He also has some computer skills. However, Mr Penney has no skills in working with inventory databases, spreadsheets etc, which would now be likely to be used for stock control systems. Nor are his computer skills at a level of competency required for this type of work type. This is borne out by the advertised positions — Appendix 5. ”
Appendix 5 is a copy of an advertisement for a position described as “Warehouse person and counter sales” where those comments are stated. 
3.
Cafe and Restaurant Manager 
After giving her advice as to what she understood the requirements of this work-type were, she then stated: 
“It is clear that Mr Penney has had experience while working in his business at the Commercial Hotel in Dargaville, working as a Barista as well as attending to the administration, over a five month period in 2007. He also attained a Bar Manager's certificate through Northland Polytechnic, which gives him a relevant qualification. He worked for a period of time as a sales representative, and has customer service skills from that as well. Whether he has had sufficient experience to gain employment will depend on the particular job he is applying for, but in my opinion, would be able to apply for both positions in Appendix 8. Furthermore, Kiwicareers describes a demand for experienced cafe and restaurant managers in the current market. My reservation about this would be that with the economic downturn, many owners are not replacing staff who leave, and are carrying out management roles themselves. ”
Appendix 8 referred to is a series of advertisements for restaurant manager, cafe team members, cafe manager. 
4.
Hotel or Motel Manager 
Again, after giving her assessment of what the requirements of this work-type are, Ms Nolan stated as follows: 
“Taking Mr Penney, he has experience in working in the hospitality industry, a Bar Manager's certificate, skills in customer service, working with staff, administrative skills in the hospitality industry and many years of experience in the building industry, both in running a business and hands on skills. In my opinion he has sufficient skills, knowledge and experience for the generic job type. ”
5.
Cost Clerk 
After identifying the work requirements Ms Nolan stated as follows: 
“Taking Mr Penney's qualifications, skills and experience, he does not have any qualifications for this work type but the VIOA relies on his experience in the building industry when estimating costs for quoting purposes, and his work in administration while helping to run the hotel business, calculating wages and other operating costs. He has also completed basic computer training. He has worked as a sales representative, so will have skills in processing orders. However, it is unlikely that Mr Penney would have accounting skills or computer skills at a level of competency required for this work type in the current market. A search of job vacancies on seek and trademejobs did not produce any available positions for a costing clerk, but there were a range of available positions for account officers in administrative roles, a sample of which are attached. The range of skills and experience required is enormous, but all call for applicants to have higher computer skills than Mr Penney has: ”
6.
Inquiry Clerk 
“Applying the ACC guidelines strictly, Mr Penney would not meet them. However, in my opinion this work type could be suitable for future employment. His experience working in the hotel will have given him the ability to deal with a range of people, such as when they are making enquiries about services, or complaints about food or service, and this skill could be transferable to both a face to face situation with customers and interaction by telephone. 
Mr Penney's lack of experience is not likely to be a major barrier to him finding work in this area, as most employers would provide on the job training, and training in produce and service knowledge. This would obviously be easier in industries where Mr Penney has worked previously, such as building. He does however lack skills in database and would need training to develop stronger computer skills …  ”
[12]
The Vocational Independence Medical Assessment requested by the respondent was carried out by Mr lain Kelman, Orthopaedic Surgeon, and he examined the appellant for the purpose on 10 February 2009. Mr Kelman had a significant amount of relevant medical reports for reference, including the previous medical assessments. With respect to the six work-types in issue, Mr Kelman stated specifically as follows: 
1.
Production Clerk 
He states that he may be able to do this work on a part time basis. 
With respect to the Work Type Detail Sheet this is sedentary work or of light physical demand. Stretching, twisting and climbing and no more than very light lifting is required. Bending, squatting and crouching movements are not significant. Repetitive arm and hand movements are only required occasionally for intermittent computer work. He has the physical ability to carry out the above tasks and therefore work 35 hours per week in this occupation. ”
2.
Stock Clerk 
He states that he could possibly work part time in this occupation. 
With respect to the Work Type Detail Sheet this is sedentary to light work. Walking and standing is allowed. Stretching, twisting, climbing, lifting and carrying are not typical components of this occupation. Bending, squatting and crouching are unlikely. Repetitive movements are intermittently for tills and computers. He has the physical ability to carry out these tasks and therefore work in this occupation 35 hours per week. ”
3.
Cafe and Restaurant Manager 
He states that he could do this work on a part time basis. 
With respect to the Work Type Detail Sheet this is sedentary work. Lifting, carrying and pulling are within the light range. Bending, squatting and crouching are unlikely. Repetitive movements are intermittently for tills and computers. He has the physical ability to carry out these tasks and therefore work in this occupation 35 hours per week. ”
4.
Hotel or Motel Manager 
He said he would be able to ‘give it a go’
With respect to the Work type Detail Sheet this is light to sedentary work. Lifting, carrying and pulling are within the light range. Bending, squatting, crouching, twisting stretching and climbing are unlikely to be required. Repetitive movements are only required for office equipment. He would be ability [sic] to carry out these physical tasks and therefore work in this occupation 35 hours per week. ”
5.
Cost Clerk 
He states that he could do this work on a part time basis. 
With respect to the Work Detail Sheet this is a sedentary position. Lifting, stretching, twisting and climbing are not significant components. Bending, squatting and crouching are not significant components. Repetitive movements are only required for office equipment. He would be able to carry out these physical tasks and therefore work in this occupation 35 hours per week. ”
6.
Inquiry Clerk 
He states that he could do this on a part time basis. 
With respect to the Work Type Detail Sheet this is a sedentary position. Walking and standing is possible. Lifting, carrying, stretching, twisting and climbing are not significant components. Bending, squatting and crouching are not significant components of this work. Repetitive movements are required only for office equipment. He is [sic] ability to carry out these physical tasks and therefore work in this occupation 35 hours per week. ”
It is to be noted that Mr Kelman determined that the 13 other work-types which had been occupationally identified would not be suitable for the appellant from a physical perspective, and he gave his reasons why in each case. 
[13]
The Independent Medical Assessment was carried out by Dr Tony Chew, an Occupational Medicine Specialist, with him examining the appellant for same on 18 February 2010, that is fully one year after the assessment had been carried out by Mr Kelman. Dr Chew identified the appellant as suffering from discogenic low back pain which he considered was a consequence of his covered injury. In respect of each of the work-types in issue, Dr Chew stated as follows: 
1.
Production Clerk 
The above job is classified in the sedentary to light physical demand category. There is requirement for stretching, twisting and climbing as well as some light manual handling. There is also requirement for some repetitive arm and hand movements for intermittent computer work. He would not be fit to perform the above job on a full time basis because of his high pain level. 
He commented that although he has the necessary skill to work in this job, he is unlikely to cope with the above job on a full time basis because of his pain. 
2.
Stock Clerk 
The above job is classified in the sedentary to light physical demand level. It requires frequent bending, squatting and crouching during inspection of goods. There is also requirement for frequent walking and/or standing about the work area to verify cargo and examine shipping documents. He is also required to sit at computer workstations on a regular basis. His spinal pain remains unresolved and he is unfit to carry out the required tasks for 35 hours or more per week. 
He commented that this is not an option at this stage due to his high pain level. 
3.
Cafe and Restaurant Manager 
The Work Type Detail Sheet indicates that the above job is classified in the sedentary physical demand category. There is requirement for frequent sitting in offices or in meeting with internal staff and suppliers. There is also requirement for lifting, carrying and pulling in some roles. Frequent repetitive hand and finger movements are required. His spinal pain remains unresolved and he is unfit to carry out the required tasks 
He commented he has a problem working in this job on a full time basis. 
4.
Hotel or Motel Manager 
The above job is classified in the sedentary to light physical demand level. There is requirement for frequent sitting in offices or in meetings. There is demand for some manual handling in some roles. He is likely to aggravate his back if he works in this job on a long term basis. His spinal pain remains unresolved and he is unable to carry out the required physical tasks for 35 hours or more per week. 
He commented this is not an option on a full time basis due to his high pain level. 
5.
Cost Clerk 
The above work type is classified in the sedentary physical demand category. It requires him to spend most of the day sitting at a workstation carrying out a variety of both manual and computerised data entry and processing tasks. Repetitive arm hand and finger movements are constantly required. His spinal pain remains unresolved and he would have difficulty carrying out the required physical tasks for 35 hours or more per week. 
He commented he is unable to work in this job on a full time basis. 
6.
Inquiry Clerk 
The Work Type Detail Sheet classified the above job in the sedentary physical demand level. It requires constant sitting at a workstation. Repetitive arm, hand and finger movements are constantly required for data-entry. His spinal pain remains unresolved and he would have difficulty carrying out the required tasks for 35 hours or more per week. 
He commented he has a problem working on a full time basis due to his pain level. 
[14]
As earlier noted, Mr Kelman was asked to comment on Dr Chew's assessment and he did so in a report dated 4 October 2010. In his report he did identify that there were differences in the appellant's physical condition in some respects from when he examined him in February 2009, and when Dr Chew examined him in February 2010. He commented on those differences as follows: 
I found no evidence of muscle spasm in the lumbar region which was recorded in Dr Chew's notes. 
The range of movement which I elicited at the time of his original examination was considerably greater than that found by Dr Chew. 
The motor power assessed in his lower limbs I considered to be normal however Dr Chew found some evidence of weakness of power in the extensor hallucis longus and the tibialis anterior. 
Mr Penney described a global loss of sensation in his lower limb not related to anatomical distributions of nerve roots or peripheral nerves however Dr Chew found that his sensation was altered only in the L5-S1 dermatome on the left. 
With respect to the individual work-types and Dr Chew's statements in respect thereof, Mr Kelman commented as follows: 
1.
Production Clerk 
“Dr Chew considered that he would not be able to perform the above job on the basis of high pain level. 
At the time I considered he had the physical requirements to carry out this work. With respect to the pain level his maximum pain he described to me as 5/10 on the Visual Analogue Scale and I considered that this was not sufficient to prevent him carrying out the above activities. ”
2.
Stock Clerk 
“Dr Chew reported the physical requirements and reported that his spinal pain remains unresolved (presumably he is referring to the lower lumbar spinal level). Dr Chew concluded that he was unable to do this job because of his high pain level. 
Very little was made of his lower spinal problems when I assessed him. His main problem was related to his thoracolumbar discomfort and taking into account his range of movement at the time that I saw him and that I felt that his level of pain in this region was at a level sufficient that he could work in this area. ”
3.
Cafe & Restaurant Manager 
“Dr Chew again recorded the physical requirements and again stated that his spinal pain was unresolved and that he was therefore unfit to work 35 hours per week. 
In the position of Cafe & Restaurant Manager as described in the Work Type Detail Sheet bending, squatting and crouching are unlikely. Repetitive movements of his upper limbs was intermittent and only for use in operating tills and computers. I consider that his pain level at the time was not sufficient to prevent him from working in this occupation. ”
4.
Hotel or Motel Manager 
“Dr Chew described the tasks and felt that he was unable to do this work because of the high pain level. 
In the position of Cafe & Restaurant Manager as described in the Work Type Detail Sheet bending, squatting and crouching are unlikely. Repetitive movements of his upper limbs was intermittent and only for use in operating tills and computers. I consider that his pain level at the time was not sufficient to prevent him from working in this occupation. ”
5.
Cost Clerk 
“Dr Chew described the physical requirements, felt that his spinal pain (again presumably lumbar pain) was unresolved and felt on this basis he was unable to carry out his tasks 35 hours per week or more. 
I consider that the physical requirements of bending, squatting and crouching were not significant components of this job. Repetitive movements were only required for office equipment. With respect to his level of pain I considered that the pain that he reported at the time of my interview would not prevent him from working in the job of a Cost Clerk. ”
6.
Enquiry Clerk 
“Dr Chew again set out the requirements and felt that he was unable to work in this area because of his pain level. 
I consider that the physical requirements of bending, squatting and crouching were not significant components of this job. Repetitive movements were only required for office equipment. With respect to his level of pain I considered that the pain that he reported at the time of my interview would not prevent him from working in the job of a Cost Clerk. ”
[15]
In her submissions in support of the appeal Miss Dao asserted as follows: 
The appellant's rehabilitation was incomplete in that there had been no psychological intervention as had been suggested. 
The appellant had not been rehabilitated to the extent of reaching vocational independence as there was clearly a need for further and specific cognitive and psychological treatment. 
The issue of the appellant's chronic pain was such that ACC should have initiated an inquiry into the appellant's mental injury, she contending that a diagnosis of a chronic pain syndrome had been made. 
Mr Kelman's assessment was flawed as he did not have a psychiatrist's opinion to assist with his assessment of the appellant's chronic pain issues. 
Mr Kelman placed too much emphasis on the appellant's statement of his level of pain on the day of the assessment, rather than on the fact that his pain level changed significantly at various times. 
Mr Kelman took no notice of the appellant's work trial problems as a consequence of pain which had limited his attendances. 
[16]
Ms Hansen, Counsel for the Respondent, made the following submissions: 
The key issue was that of the appellant's back pain and how it might limit his abilities. Mr Kelman advised that his maximum level of pain would have been 5/10. 
Mr Kelman was well aware of the appellant's clinical history and of the work trials that he had engaged in. 
The relevant point of time for the consideration of the appellant's suitability was February 2009 and not February 2010 when he was seen and examined by Dr Chew. 
Decision 
[17]
The respondent's decision, which is the subject of this appeal, is one of the most significant decisions which can be made affecting a claimant and it therefore requires clear evidence that the statutory requirements for the making of such a decision have been established. 
[18]
The Occupational Assessment must be shown to identify work-types which are suitable for the claimant because they match the skills that the claimant has gained through education, training or experience. The Medical Assessment must identify that one or more of those work-types so identified are capable of being undertaken by the claimant for 35 hours or more per week. It is of course the case that a decision of vocational independence supersedes the Corporation's previous decision that a claimant is incapacitated within the meaning of the Act. 
[19]
In the present case I am satisfied that the respondent carried out the two Vocational Independence Assessments in accordance with the relevant statutory provisions pertaining thereto, and it is the case that those assessments identified six work-types as being both occupationally and medically sustainable by the appellant. It must therefore be the case that prima facie the appellant's vocational independence in respect of those work-types had been established. 
[20]
It is also relevant to identify that earlier Initial Vocational Independence Assessments had come to similar conclusions about the appellant's occupational abilities, and it was the case that the medical assessment of Dr Gollop in September 2007 identified that with a further lapse of some six months or more, those work-types ultimately found to be medically sustainable would in fact be medically sustainable, and it is the case that the medical assessment to that effect was carried out by Mr Kelman some sixteen months after Dr Gollop's assessment and note of the appellant's future potential. 
[21]
As I have earlier identified, Ms Nolan who carried out an independent occupational assessment, also gave her opinion of the appellant's physical abilities in respect of the requirements of the various work-types, and a significant amount of her assessments were in relation to her opinion of the appellant's physical restrictions in respect of those work-types. 
[22]
This is not the first time that this Court has been referred to an Occupational Assessment by Ms Nolan, where she has adopted that procedure and this Court has on previous occasions identified that her opinion cannot be accepted from a medical perspective because she is not a person with the necessary medical qualifications to provide such an opinion. 
[23]
As I identified earlier, it is the case that from an occupational perspective, Ms Nolan acknowledged that the appellant had the necessary skills, training or experience to undertake the various requirements of those work-types, and therefore from the legal perspective which the Court must apply, I find that there is no basis for a determination that the six work-types in issue were not occupationally suitable for the appellant, having regard to the skills he had gained through education, training and experience. 
[24]
The medical aspect of this case concerns the limitations caused by the appellant's lower back pain, described as chronic pain, and I have earlier identified that Mr Kelman took proper cognizance of that chronic pain when considering the appellant's physical abilities in respect of the various work-types. 
[25]
One of the principal submissions made by Ms Dao was that the medical assessment was carried out without there being any input from psychiatric or psychological considerations, there having been none undertaken by the respondent in the period leading up to the date of the assessment. It was Counsel's submission that the issue of the appellant's chronic pain was such that ACC should have initiated an inquiry into the appellant's mental injury. 
[26]
I have considered the various references to which Counsel referred in relation to this aspect and in effect, I find that the issue of psychiatric intervention has been misunderstood. 
[27]
The first occasion referred to by Counsel was in a Functional Reactivation Report from a physiotherapist, Carolyn Wilson, who in October 2008, when identifying the appellant's then condition, stated inter alia. 
“So my recommendation is for a Work Hardening Programme with the possibility of seeing Lorette Longmann, a Psychologist based north of Dargaville for some one on one psychology sessions on Cognitive Behaviour Therapy side of Pain Management and addressing barriers to RTW. ”

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