austlii:nsw/NSWPIC/2025/257
General information, not legal advice.
NSWPIC
2025-06-10
Original judgment source is linked above.
A brief statement is attached setting out the Commission's reasons for the determination.
PROCEDURE BEFORE THE PERSONAL INJURY COMMISSION
(a) Application to Resolve a Dispute and attached documents;
(b) Reply and attached documents, and
(c) Application to lodge additional documents dated 16 April 2025, and attached documents.
"1. Lower back pain with radiculopathy to the left leg
3. Headache (nil vomiting, nil visual disturbances)
9. Acute Stress disorder - worse when moving with pain"
In a clinical note dated 15 November 2023, Dr Kako continued to note bilateral knee pain, worse in the left knee. He also noted that in respect of issues arising since the previous consultation, there was persistent pain, and also "right side compensating".
Subsequent notes recorded low mood, pain, insomnia, anxiety and being pain focused, as well as continuing pain symptoms in the neck, middle and lower back and both knees, left worse than right.
Clinical notes of Mr Hurmoz, psychologist, commenced 2 November 2023. The initial note recorded a history of prior work in Iraq as an interpreter and arrival in Australia by boat in 2012 with subsequent time in a detention centre. Mr Hurmoz took a history of injury at work, followed by feeling much pain and very low mood and dissociation. Mr Hurmoz recorded that the were no injuries or health problems before.
In a note dated 25 November 2023 Mr Hurmoz said that he provided the applicant with a "diagnosis of MDD". In the context of the notes referred to below, I infer that this was a reference to major depressive disorder.
A referral letter dated 14 June 2024 by Dr Kako to Dr Blagoje Kuljic stated:
"Thank you for seeing Abather Akbawy, a 38 yrs year old Male for opinion and management of severe depression, anxiety, stress disorder, panic disorder and self harm ideatio [sic]. Abather sustained significant pain in his back following a workplace injury and his mental health has since deteriorated. He continues to suffer from radiculopathy and reports severe insomnia, flashback and intrusive thoughts.
Dr Dias disagreed with the opinion of Dr Rimmer, whom Dr Dias characterised as essentially ignoring reports of symptomatology and physical examination findings and attributing them to abnormal illness behaviour or lingering. Dr Dias was of the view that this ignored the overwhelming contemporaneous medical evidence to the contrary.
Dr Dias was of the opinion that the applicant is totally unfit for any form of suitable employment due to persisting symptoms and disabilities coupled with heavy daily use of analgesia and associated psychiatric comorbidity.
Dr Rimmer, orthopaedic surgeon, provided reports to the workers compensation insurer and its solicitors.
In his report dated 19 October 2023, Dr Rimmer recorded a history of an incident at work while the applicant was working on a handrail when he slipped on the concrete and fell backwards and he was unable to stand due to pain in the spinal column. He noted treatment at the Westmead Hospital and examination and thereafter discharge on the same day.
Dr Rimmer noted that on that occasion no radiological investigations were available. He noted documentation including an MRI lumbar and thoracic spine report dated 25 August 2023.
Dr Rimmer recorded current symptoms as descriptions of pain in the cervical spine and the thoracolumbar spine, with no evidence of radiculopathy to either the upper limbs or the lower limbs.
Dr Rimmer noted that the actual image of the MRI scan of the spinal column needed to be reviewed for the purpose of assessment. He diagnosed musculoskeletal strain of the cervical spine, thoracolumbar spine and abnormal illness behaviour, "without the benefit of radiological investigations", which he said he needed to review the actual MRI scan to confirm diagnosis. He noted a "tendency to over exaggeration". Dr Rimmer was of the view that the applicant had become pain focused, demonstrating abnormal illness behaviour.
Dr Rimmer was of the view that, based on the history and examination on that occasion, the applicant had no capacity for work.
In a "file review" report, Dr Rimmer noted a nuclear bone scan report dated 6 November 2023. Dr Rimmer also noted an MRI scan report of the lumbar spine dated 25 August 2023 showing no abnormality, and that he disagreed with that report.
Dr Rimmer was of the opinion that given the normal imaging of the spinal column, his diagnosis was overwhelmingly abnormal illness behaviour/malingering. He was of the view that any soft tissue injury that had been sustained to the cervical or thoracolumbar region had "well and truly resolved". Dr Rimmer was of the view that all imaging of the spinal column showed no significant abnormality. He was of the opinion that there were gross inconsistencies between reported symptoms, demonstrated level of capacity and the objectively identified pathology which was that all imaging of the spinal column showed no abnormality.
Dr Rimmer commented that given that extensive investigations of the spinal column showed no abnormality, confirming a diagnosis of abnormal illness behaviour/malingering, he recommended "period of surveillance".
In his report dated 19 December 2024, Dr Rimmer re-examined the applicant and noted that upon specific questioning the applicant said that he had no pain in either the left or right shoulders or right knee, "either acutely or consequently". Dr Rimmer noted that this was consistent with the history provided at initial assessment.
On examination, Dr Rimmer noted complaint of neck pain, normal examination of both upper limbs, and mild tenderness to firm palpation throughout the thoracic and lumbar spine. He reviewed an MRI scan of 25 August 2023 which he said showed minor disc degeneration at T 9/10 with no neural impingement and disc degeneration and bulging at L5/S1 with no neural impingement. He noted that the previously mentioned bone scan showed no abnormality.
Dr Rimmer diagnosed resolved musculoskeletal strains of the lumbar spine, thoracic spine and cervical spine. He stated that there was no diagnosis in respect of the right knee or either shoulder.
Dr Rimmer noted that in his view there were gross inconsistencies. He stated that when the applicant was viewed informally in the waiting area he moved with relative ease which was in marked contrast to the commencement of the formal examination.
He was of the opinion that the applicant had not suffered a right knee, right shoulder or left shoulder condition separate to or pre-existing the injury. He maintained his earlier opinion.
Dr Rimmer was of the opinion that the applicant could return to pre-injury duties.
Dr Rimmer stated that the fundamental difference between his opinion and that of Dr Dias was that Dr Rimmer did not believe that the applicant had any genuine physical impairment.
Dr Kako in my view supports the applicant's statement that due to the difficulties with left knee pain he compensated on his right side and sustained right knee pain over time. Bilateral knee pain, left worse than the right, had been recorded by Dr Kako since August 2023, but it was the consultation in November 2023 that noted persistent pain as an issue arising from the previous consultation with reference to right-sided compensation. 9. Dr Dias accepted the applicant's history that he continued to struggle with ongoing symptoms of pain, stiffness and discomfort affecting various parts of his body including his knees on a continual basis over the course of the past 12 months following the subject work-related accident. Dr Dias on examination noted a significant antalgic gait pattern favouring the left lower limb. He noted the right knee was tender to palpation. 10. In respect of a diagnosis or finding of stiffness in the right knee, in my view the report of
Dr Dias should be read as a whole, with reference to his acceptance of the applicant's history of stiffness in various parts of his body as a result of the subject injury, including his right knee. 11. Dr Dias's findings on examination included a notation of a significant antalgic gait pattern favouring the left lower limb, which in my view is in accordance with the applicant's evidence that he favoured his left knee by compensating for his right knee. This notation on examination by Dr Dias is also in accordance with the clinical note of Dr Kako of
15 November 2023, referred to above. 12. It is not necessary for the opinion of Dr Dias to correspond with complete precision to the proposition upon which he has based his opinion, that is that the applicant compensated on his right side for the left knee pain. Dr Dias observed an antalgic gait pattern favouring the left lower limb and stated that the symptoms he observed in the right knee were secondary to an acute soft tissue injury. In my view this represented a fair climate[2] for the opinion that he expressed. 13. Further, the report of Dr Dias should be read together with the other evidence noted above, that is the applicant's statement and also the clinical note of Dr Kako of 15 November 2023. That is, a deficiency in this part of his report can be "made good by other material, either in another report or in oral evidence"[3]. In this case what might be seen as a deficiency, which in any event I do not accept, is made good by the clinical note of Dr Kako of 15 November 2023. 14. The relationship between the right knee symptoms and the left knee injury, that is the overcompensation of the right knee as a result of the pain in the left knee, is in the circumstances of the matters noted above such an obvious connection that it requires no further explanation by Dr Dias.[4] 15. It is not determinative that there are no radiological findings of pathology in the right knee in the context of a claim for a consequential right knee condition. It is not necessary for the applicant to establish that he suffered injury to his right knee. All that is required is that the applicant establishes that the symptoms and restrictions in his right knee have resulted from his left knee injury.[5] As was observed in Kooragang Cement Pty Limited v Bates,[6] "what is required is a common sense evaluation of the causal chain". 16. In this case, the causal chain was that following the injury to his left knee on 2 August 2023 the applicant complained of bilateral knee pain, left worse than the right, and on
15 November 2023 it was noted in accordance with the applicant's statement that there was right-sided compensation, and Dr Dias also noted a significant antalgic gait pattern favouring the left lower limb. 17. At this point, it is necessary to turn to the opinion of Dr Rimmer. 18. In summary, Dr Rimmer did not accept the applicant's complaints of pain and restrictions generally, characterising them as abnormal illness behaviour or malingering, and a lack of complaint in respect of the right knee. Dr Rimmer did not accept that the relevant imaging demonstrated pathology that supported complaints of pain in the cervical and thoracolumbar spine. 19. In my view, the observations of Dr Rimmer are not in accordance with the clinical and medical evidence. The clinical notes of Dr Kako recorded and accepted continuing complaints of pain in the neck, the back and both knees. Dr Singh accepted and recorded significant and continuing upper and lower back pain, which he related to the subject injury and findings on imaging and examination. Mr Nguyen noted and accepted severe pain in respect of the neck, back and knees. Mr Hurmoz noted and accepted continuing complaints of pain. Dr Dias recorded and accepted continuing complaints of neck, upper and lower back and bilateral knee pain, which he related to the subject injury. This evidence in my view supports genuine complaints of pain by the applicant.
In my opinion, this evidence also supports continuing complaints of right knee pain, contrary to the history recorded by Dr Rimmer.
Accordingly, I do not prefer the opinion of Dr Rimmer, either as to the right knee, or generally.
In respect of the claimed psychological condition, the respondent submitted that the only evidence in support was the applicant's statement and some notes from a psychologist but no report. It was submitted that there was no diagnosis and there was nothing to suggest that there was a psychological injury aside from a mere description of psychological symptoms. It was submitted that there was no medical evidence in support of a psychological injury from a psychiatrist. It was submitted that any such opinion should have regard to the prior history of the applicant leading up to his arrival in Australia.
I do not accept the submissions of the respondent. As noted above, the initial certificate of capacity related an acute stress disorder to the subject injury. The certificate of
24 October 2023 recorded that on 24 August 2023 there was "sever insomnia, frustration and panic attack..."
Thereafter, the clinical records noted a history of acute stress disorder, severely low mood and anxiety, and a deterioration in mental health. Mr Hurmoz, psychologist, recorded a similar history and provided a diagnosis of "MDD", which I have inferred from the context as being a reference to major depressive disorder.
The referral letter dated 14 June 2024 of Dr Kako in my view provided a diagnosis of severe depression, anxiety, stress disorder, panic disorder and self harm ideation, which he related to significant pain in the back following a workplace injury and subsequent mental health deterioration. In my view, the diagnosis provided by Mr Hurmoz supports this diagnosis. I do not accept the submission that there were two different diagnoses, as in my view the diagnosis of Dr Kako, which included severe depression, is not inconsistent with that of
Further, Dr Dias noted and identified SNRI antidepressant medication treatment. Although
Dr Dias is not a psychiatrist, in my view a medical practitioner is qualified to identify this medication.
(a) the opinion of Dr Dias as to capacity was based upon not only the accepted injuries, but also all body parts and the disputed conditions including the psychological condition and the GORD condition as it related to the heavy use of medication;
(b) there was a marked contrast between the examinations by Dr Singh and Dr Dias and that there was no explanation for that marked contrast;
(c) although Dr Singh was of the opinion that the applicant had no capacity for work resulting from his lumbar spine condition, by the later time that Dr Dias examined the applicant it was the opinion of Dr Dias that there was no capacity for work for all the conditions assessed and therefore the contribution of the lumbar spine condition to capacity was accordingly a much smaller component by the time of assessment by Dr Dias, and
(d) Dr Rimmer provided the best explanation in his opinion for capacity when he found an examination that from a physical perspective the applicant is fit for pre-injury duties with immediate effect and that the overwhelming barrier to the applicant returning to work is abnormal illness behaviour and malingering.
In my view, these findings are not inconsistent with those recorded by Dr Singh, who noted pain in the lower and upper back, with the back pain being noted as continuous and significant. By 19 March 2024, Dr Singh was of the opinion that the applicant was unable to work because of the lumbar injury and lower back pain with leg pain.
I do not accept the respondent's submissions that there was a marked contrast between the examination findings of Dr Dias and Dr Singh. The former examined and considered all injuries, while the latter examined and considered the back and lumbar spine, but Dr Dias's view that the applicant had no capacity due to the injuries he considered does not exclude the conclusion that a subset of those injuries, that is the back and lumbar spine, has alone resulted in there being no capacity for work, as opined by Dr Singh.
While Dr Dias found marked restriction of range of movement in the lumbar spine, and
Dr Singh in his initial report did not, it is necessary to consider all of the reports of Dr Singh. The range of motion findings by Dr Singh, were initially noted as normal in December 2023, and were not noted in later reports. Dr Singh attributed significant and continuous pain to disc herniation in the lumbar spine, and he assessed capacity as noted above. In my view, consideration of the opinion of capacity provided by Dr Singh should have regard to the totality of his reports, and should not be limited to the range of motion findings on initial examination.
I have accepted and found that the applicant's psychological and right knee conditions resulted from the injury of 2 August 2023. Thus, Dr Dias in his opinion as to capacity considered accepted injuries or conditions in respect of the applicant's cervical spine, thoracic and lumbar spine, both knees and psychological condition. He also considered analgesic medication intake for chronic pain associated with the applicant's injuries, which in the clinical notes of Dr Kako were recorded as being for back pain. The applicant's shoulder pain was regarded by Dr Dias as being referred pain from the neck.
The only matter not claimed in these proceedings was an acute concussive head injury diagnosed by Dr Dias, with continuing chronic headaches, fatigue and difficulty with concentration and short term memory. Although the contribution of the head injury to capacity was not explained by Dr Dias, it seems to me on a broader reading of his report that Dr Dias recorded the head injury as one among many injuries and conditions, with no prominence given to that condition.
On balance, in my view the opinion of Dr Dias supports a finding of no capacity for work resulting from injury sustained on 2 August 2023, and conditions resulting from that injury, to the applicant's cervical spine, thoracic spine, lumbar spine, both knees, and psychological condition. The psychological condition was expressed by Dr Dias as an insurmountable barrier to re-entry into the workforce, which I accept as contributing to the applicant's incapacity for work, having regard to the requirements of s 32A of the 1987 Act, that is the nature of his incapacity viz suitable employment, in addition to all the other accepted body parts.
In my view, the above evidence also supports my finding that in respect of all of the injuries and conditions that have been accepted or found as resulting from the injury of 2 August 2023, all such injuries and conditions have continued to date.
The opinions of Dr Singh and Dr Dias support my finding that the applicant has, and has had on a continuing basis since 2 August 2023, no current work capacity as a result of injury sustained in the course of employment on 2 August 2023. I find that the applicant is not able to return to work, either in his pre-injury employment or in suitable employment.
Pre-injury average weekly earnings (PIAWE) were agreed at $1,481.96. This will be subject to the required indexation increases from time to time.
There will be an award pursuant to s 37(1) of the 1987 Act that the respondent pay the applicant $1,185.57 per week (and as indexed) from 19 February 2024 to date and continuing, in respect of PIAWE of $1,481.96 (and as indexed).
[1] [2009] NSWCA 227 at [2].
[2] Paric v John Holland (Constructions) Pty Ltd [1984] 2 NSWLR 505 at 509-510; Paric v John Holland (Constructions) Pty Ltd [1985] HCA 58; (1985) 62 ALR 85).
[3] Hancock v East Coast Timber Products Pty Ltd [2011] NSWCA 11; 80 NSWLR 43 at [92].
[4] Sydneywide Distributors Pty Ltd v Red Bull Australia Pty Ltd [2002] FCAFC 157 at [88]- [89], discussed in Moon v Conmah Pty Limited [2009] NSWWCCPD 134 (Moon) at [49].
[5] Moon at [48], Kumar v Royal Comfort Bedding Pty Ltd [2012] NSWWCCPD 8 at [49].
[6] (1994) 35 NSWLR 452 at 464.
Akbawy
Hays Specialist Recruitment
(1985) 62 ALR 85
(1994) 35 NSWLR 452