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[2001] VSCA 148
Court of Appeal (Vic)
2001-09-07
ORMISTON, PHILLIPS and BATT, JJ.A.
Original judgment source is linked above.
Accident compensation - Workers' compensation - Entitlement to weekly payments after 104 weeks - Dependent upon worker's having "serious injury" or being "totally and permanently incapacitated" - "Serious injury", previously afflicting the worker, ceasing upon change in the legislation - Finding that worker "totally and permanently incapacitated" thereafter - Whether in conflict with opinion of medical panel that worker subsequently "partially and permanently incapacitated" - Effect of medical panel's opinion - Absence of any intervening event or change in circumstances of significance - Accident Compensation Act 1958 s.93B(3).
opinion and on 27 May 1998 the medical panel provided a certificate of opinion on those four questions. Question 2 and its answer read as follows:-
"Q: On the balance of probabilities, is the plaintiff either wholly or partially incapacitated for work or suitable employment and if so, what is the extent of such incapacity and will such incapacity be permanent? A: It is the opinion of the Panel that the plaintiff is partially incapacitated. This incapacity will be permanent. It will affect his ability to work in an area where heavy lifting and frequent bending is required and in addition, it would affect his ability to maintain a static posture, either sitting or standing for prolonged periods."
The important part of this opinion was that the plaintiff "is partially incapacitated" and that "this incapacity will be permanent"; for, by virtue of s.68(4) of the Act, "for the purposes of determining any question or matter", that opinion was "to be adopted and applied by [the] court ... and must be accepted as final and conclusive ...". About that there is no dispute.
"4. The Defendant to pay the Plaintiff weekly payments of compensation from 9 March 1994 to 26 May 1998 as follows: (a) At 95 per cent of his pre-injury average weekly earnings for the first 26 weeks of this period. (b) At the rate of 90 per cent of the Plaintiff's pre-injury average weekly earnings, and being the rate appropriate for serious injury from the expiry of the said 26 weeks period until 13 November 1996 inclusive. (c) At the rate of 70 per cent of the Plaintiff's pre-injury average weekly earnings, being the rate appropriate for total and permanent incapacity from 14 November 1996 to 26 May 1998 inclusive."
The award of weekly payments until 13 November 1996
"93B. After 26 weeks incapacity (1) A worker is entitled, subject to and in accordance with this Part, to weekly payments while incapacitated for work (not being a period during the first 26 weeks of incapacity) at whichever of the following rates apply- (a) if the worker has a serious injury - (i) and has no current weekly earnings, the rate of- (A) 90 per cent of the worker's pre-injury average weekly earnings; ... (b) if the worker does not have a serious injury but is totally incapacitated, the rate of- (i) 70 per cent of the worker's pre-injury average weekly earnings; ...". [Emphasis added]
The expression "serious injury" was defined in s.93B(5) to mean injury occasioning a level of impairment of 30 per cent or more if assessed according to the methods specified in the American Medical Guidelines to the Evaluation of Permanent Impairment (2nd edition).
"The plaintiff impressed me as an honest witness. It is clear that he was a very conscientious man in the performance of his work and that the injury he suffered to his back not only constituted a severe physical injury, but also has eroded his self esteem resulting in significant psychiatric sequelae. The injury to the plaintiff's back from when he injured it on 9 March 1994 to the date of the opinion of the Medical Panel, has caused the plaintiff severe low back pain with associated restriction of movement. He has been totally incapacitated from carrying out the work which he did prior to the injury, or any suitable employment as defined in s.5 of the Act. His back pain has resulted in severe pain in the right leg. The medical reports which have been tendered provide an overall picture of a severely incapacitated and distressed plaintiff who prior to the Medical Panel's opinion had spent more than four years trying to cope both physically and mentally with the severe injury he had suffered to his back."
This led the judge to make a lump sum award for "pain and suffering" under s.98A(5) of 60 per cent of the maximum.
"From 9 March 1994 until 14 November 1996 when a new s.91 inserted by Act 60/1996[1] came into force, psychiatric or psychological injury, impairment or symptoms arising as a consequence of, or secondary to, a physical injury, were included for the purpose of deciding whether a worker had suffered a serious injury within the meaning of s.93B(5) of the Act. On 14 November 1996 [a new s.91] came into force [which excluded such considerations]."
His Honour had before him formal assessments of the plaintiff which spanned a period of some 20 months but, as his Honour observed, he had had "the opportunity to review the effects of the plaintiff's injuries upon him over a period of more than four years". On the evidence, the judge considered that the reasonable inferences were that there had been "little or no change in the plaintiff's long term whole person impairment during that period of more than four years" and that accordingly the plaintiff had a 15 per cent whole person psychiatric impairment from 9 March 1994 until 26 May 1998. The physical impairment throughout that period was 20 per cent. His Honour then concluded:-
"Adopting the principles laid down in Dahl & Anor. v. Grice [1981] VicRp 50; [1981] V.R. 513, I find that the plaintiff had a physical whole person impairment of 20 per cent throughout the period of four years. When a full psychiatric impairment of 15 per cent is added up to 13 November 1996, a combined AMA assessment of 32 per cent results, which represents a serious injury pursuant to s.93B(5). However, as from 14 November 1996 pursuant to [the new] s.91(2) ...., only the plaintiff's primary psychiatric impairment of 7.5 per cent can be taken into account and the addition of the plaintiff's physical impairment and psychiatric impairment results in a converted total of 26 per cent from that date onwards, which falls short of the 30 per cent required by the definition of `serious injury'".
The award of weekly payments from 14 November 1996.
"However, on the totality of the evidence I find that the plaintiff was at that date [14 November 1996] totally and permanently incapacitated and remained so until 26 May 1998."
On its face this would have justified an award of weekly payments under s.93B(1)(b), which applied in terms if the worker was totally incapacitated. The difficulty lay in the fact that on 27 May 1998 the medical panel had certified its opinion of partial and permanent incapacity and by that the judge was bound, by virtue of s.68(4) of the Act. On that account payments were not ordered beyond 26 May 1998. Certainly in the light of the opinion of the medical panel weekly payments could not be justified after 26 May 1998 under s.93B(1)(b), for that provision depended upon total incapacity, not partial; and although s.93B(1)(c) provided for weekly payments at a different rate in a case of partial incapacity, by May 1998 some four years had passed since the injury sustained on 9 March 1994 and s.93B(3) denied entitlement to weekly payments after 104 weeks, save in limited circumstances. These included serious injury but did not include partial incapacity, and it is upon that provision that this appeal turns.
"(3) The worker's entitlement to weekly payments under this section ceases after the worker has been incapacitated for 104 weeks unless the worker- (a) has a serious injury; or (b) is totally and permanently incapacitated."
In itself this subsection must have denied to the plaintiff any entitlement to weekly payments under the preceding subsections as from 9 March 1996 (the expiry of the 104 weeks), had it not been for the judge's finding of serious injury. That finding lasted only until 13 November 1996 because (as the judge saw it) of the change in the legislation that occurred the day after, on 14 November. From that day any entitlement depended solely upon the judge's finding that the plaintiff was totally incapacitated, a finding which was in conflict (the employer submits) with the opinion of the medical panel expressed on 27 May 1998, especially as the judge's finding was that the total incapacity afflicting the plaintiff (which was relevant from 14 November 1996) was permanent. How could the total incapacity be permanent, the employer asks, if on 27 May 1998 the medical panel found it to be only partial? And if not total, there can have been no entitlement in the plaintiff to weekly payments on and after 14 November 1996 when he ceased to be afflicted by "serious injury" as defined.
"While at first glance the total and permanent incapacity assessment I have made, when compared with the opinion of the Medical Panel, might suggest a miracle cure, it may well find its basis in the application of different factors to the concept of `incapacity'."
His Honour then referred to the definition of "total incapacity", which had been inserted in s.5(1) of the Act by s.6(m) of Act No. 67 of 1992[2] (with effect from 1 December 1992) and later repealed (as from 12 November 1997) by s.30(1)(e) of Act No. 107 of 1997[3], and also the definition of "suitable employment" upon which that definition of "total incapacity" had drawn. Perhaps his Honour had in mind that the factors which were relevant to "total incapacity" as defined between 1 December 1992 and 12 November 1997 became somewhat different after 12 November 1997 (and thus by the time the medical panel came to express its opinion) but if so it was a difference which plaintiff 's counsel did not seek to identify for us in argument and so a difference upon which he did not seek to rely for the purposes of the appeal. In short, the judge's reference to the possibility of "different factors" applying to "the concept of incapacity" was something not explored in argument and the contrast between the judge's finding of total and permanent incapacity on 26 May and the panel's opinion of partial but permanent incapacity on 27 May is not to be explained, it seems, by a change in the legislation.
"The vital contrast between temporary and permanent incapacity must be based upon an assessment of future prospects at the time the decision is made. It is not inconsistent with the notion of permanent incapacity that the pensioner's position should be reviewed from time to time. Unexpected improvement in the person's condition, advances in medical science, the achievement of fresh skills, or even changes in the labour market, could bring to an end an incapacity which had been thought to be permanent. In my view the true test of a permanent, as distinct from temporary, incapacity is whether in the light of the available evidence, it is more likely than not that the incapacity will persist in the foreseeable future."
It is unnecessary for present purposes to resolve the question, considered in that case, whether it was better to describe permanent incapacity as incapacity which was "likely to persist in the foreseeable future" or as "likely to last indefinitely", or even as "likely to last forever". (I simply note in passing that in AMP Workers Compensation Services v. Chalkley[6] (13 August 1998, unreported) McDonald, J. was content to adopt the first of these three, in line with what I have just quoted from the judgment of Woodward, J.) For present purposes the relevant point is this: that, whatever the true test might be of a permanent, as distinct from a temporary, incapacity, the test must be applied at a given time and in the light of the circumstances as they are, according to the evidence before the fact finding tribunal. As McDonald, J. said in Chalkley[7], in relation to the phrase "totally and permanently incapacitated" as now appearing in the Accident Compensation Act:-
"The issue of a worker's incapacity and whether it is total at a particular time or whether it is total and permanent at a particular time may well vary as a fact from time to time. The finding by the court on 30 November 1994 that Chalkley [the worker] was totally and permanently incapacitated did not give rise to an estoppel preventing the appellant [the employer's insurer] from raising in subsequent proceedings between it and Chalkley the issue, that at a time subsequent to the finding of the court, Chalkley was then not totally incapacitated or not totally and permanently incapacitated. The finding that as at 30 November 1994 Chalkley was totally and permanently incapacitated was no more than a finding that it was more likely than not that such incapacity would persist in the future but it was not determinative of whether such incapacity did in fact persist in the future."
It can be accepted, then, that a finding of total and permanent incapacity is made at a given time but about the future and so must be capable of review if circumstances subsequently change significantly. Woodward, J. suggested a number of possible changes in circumstances which could perhaps justify a change from permanent to temporary incapacity, but nothing like that happened here; nor indeed was there time in view of the judge's finding up until 26 May 1998. Nothing of significance occurred on that day so there was nothing to justify or explain the change in the plaintiff's condition, from total incapacity on 26 May to partial incapacity on the day after.
"a soldier whose capacity, as a result of the war, has been so reduced as to preclude his earning other than a negligible percentage of a living wage, or who cannot be usefully employed in national workshops or provided with such other employment as is approved by a State Board and whose total incapacity is likely to continue indefinitely."
"The Commission was, therefore, called upon to decide whether the worker had been permanently and totally disabled, an expression which, in our opinion, means physically incapacitated from ever earning by work any part of his livelihood. This condition is satisfied when capacity for earning is gone except for the chance of obtaining special employment of an unusual kind."
See also and compare clauses 1(b)(iv) and (v) of the clauses to s.9 of the Workers Compensation Act 1958 (Vic.) and the discussion of incapacity in Hill & Bingeman, Principles of Workers' Compensation (1981)at p.81.
find that the plaintiff was only partially (though permanently) incapacitated on 27 May 1998, to find that he was none the less totally and permanently incapacitated before and up until that date. That being error (and in my opinion error of law), the order for weekly payments from 14 November 1996 to 26 May 1998 was also error. By virtue of s.93B(3) the plaintiff ceased to be entitled to weekly payments on 14 November 1996 when he ceased to have a "serious injury" and was not "totally and permanently incapacitated".
[1] Accident Compensation (Further Amendment) Act 1996 s.9
[3] Accident Compensation (Miscellaneous Amendment) Act 1997
[11] Compare also, of the Comonwealth, the Superannuation Act 1976 s.54B which attributes meaning to the description of a person as "totally and permanently incapacitated"; the Veterans' Entitlements Act 1986 s.24(1)(b) which provides a special rate of pension for the veteran who is "totally and permanently incapacitated" as described therein; and the Superannuation Act 1990, First Schedule, clause 1.1.1 which contains a definition of "totally and permanently incapacitated". In the Australian Capital Territory, see Workmen's Compensation Ordinance 1951-59, First Schedule para.13, which excludes redemption by lump sum in a case of "total and permanent incapacity"; see also ss.10(1), 12(2). In South Australia the phrase "total and permanent incapacity" appears in the Workers Rehabilitation and Compensation Act 1986 s.43(9). In Western Australia, the expression "totally and permanently disabled" appears in reg.5 of both the Fire Brigades (Superannuation Fund) Regulations 1986 and the Coal Industry Superannuation Regulations 1990; while "total and permanent disablement" is defined in the State Superannuation Regulations 2001, reg.3. In Queensland the phrase "total and permanent disablement" is defined in the Parliamentary Contributory Superannuation Act 1970 s.18A, and also in at least two of the deeds made under the Superannuation (State Public Sector) Act 1990.
[12] [1933] HCA 58; (1933) 50 C.L.R. 328 at 338.
Ajinvan P/L
Laurie Fry [2001] VSCA 148