1. The applicant claims a direct injury to her right lower extremity (knee). She also claims a consequential injury to her left upper extremity (wrist) in the nature of a left-sided carpal tunnel condition as well as weekly payments of compensation pursuant to s 38 of the Workers Compensation Act 1987.
2. The applicant seeks orders that the respondent pay for surgery proposed for her left-sided carpal tunnel syndrome and knee replacement surgery for her right knee.
3. The respondent does not deny that these medical procedures are reasonably necessary.
4. The respondent contends that there is no causal connection between the fall on

6 August 2022 and the applicant's right knee condition. 5. The respondent contends that there is no causal connection between the immobilisation of the applicant's right arm following shoulder surgery, for which liability is accepted, and the development of the applicant's subsequent left-sided carpal tunnel syndrome.

PROCEDURE BEFORE THE PERSONAL INJURY COMMISSION

1. Mr Andrew Parker of counsel, instructed by Firths the Compensation Lawyers appeared for the applicant. Mr Andrew Davis of counsel, instructed by Gallagher Bassett Services Pty Ltd, appeared for the respondent.
2. I am satisfied that the parties to the dispute understood the nature of the application and the legal implications of any assertion made in the information supplied. I used my best endeavours in attempting to bring the parties to the dispute to a settlement acceptable to all of them. I am satisfied that the parties have had sufficient opportunity to explore settlement and that they were unable to reach an agreed resolution of the dispute.
3. The application was heard on 24 November 2025.
4. On 21 November the respondent lodged an Application to Lodge Additional Documents being a report of Dr Wallace of the same date.[1] In the application the respondent contended that:

"In the Direction issued by Kerry Haddock on 13 October 2025 at paragraph 5, the respondent was directed to file and serve the report of Dr Wallace within 7 days of receipt. The report was received at 5:33PM on 21 November 2025, and it has been served on the applicant and filed by way of Application to Lodge Additional Documents at 6:00PM on 21 November 2025.

A failure to allow the Respondent to file the attached documents would result in an injustice and serious prejudice to the Respondent. It is submitted that equity, good conscience and the substantial merits of the case without regard to technicalities or legal forms require that all relevant material be before the Commission to enable the proper consideration of the matter. This accords with the objects of the Commission as set forth in Section 367 WIM Act.

It is submitted that as the Commission, pursuant to Rule 71(c), is required to take such measures as are reasonably practicable to ensure the parties have the fullest opportunity practicable to ensure to have their case considered without compromising the objectives of the Commission, it is appropriate to permit the attached documents to be filed. Allowing the filing of the attached documents would not result in any compromise of the objectives of the Commission, and in particular, would not compromise the objective to provide a fair and cost-effective system for the resolution of disputes under the Workers Compensation Act and may lead the parties to a durable agreement in accordance with the Workers Compensation Act.

Allowing the filing of the attached documents would assist the Commission in its consideration of the matters in dispute in these proceedings.

It is in the interests of justice for relief pursuant to Rule 6(2) to be granted in respect of the filing of the attached documents.

The late admission of the documents will not cause undue delay. The Applicant suffers no damage.

Allowing the filing of the attached documents would assist the Commission in its consideration of the matters in dispute in these proceedings."

1. Applicant's counsel opposed the admission of the report. Although he conceded it was served in accordance with Member Haddock's direction i.e. within seven days of its receipt by the respondent's representatives, it was in fact served after close of business on the Friday before the hearing. The applicant's representatives did not receive the report until the following Monday, the morning of the hearing.
2. The request for the report was delayed by a month as a result of an administrative failure to act promptly and an administrative hiccup in that the appointment was originally been requested from the wrong practice.
3. Applicant's counsel noted various new issues raised in the report by Dr Wallace and relied on prejudice to the applicant arising from the receipt of the report on the morning of the hearing.
4. Previous reports of Dr Wallace were available to the parties.
5. The preparation of the report under consideration did not involve a re-examination of the applicant.
6. Having considered the balance of convenience, and possible prejudice to the parties, I refused the admission of Dr Wallace's report.
7. The hearing proceeded beyond the listed time without conclusion. Therefore, the respondent was provided with an opportunity to provide written submissions and the applicant an opportunity to respond to those.

1. There was no oral evidence.
2. There was no application to adduce oral evidence or cross examine the applicant or any other witnesses as to any factual dispute before the Personal Injury Commission (Commission).
3. The following documents were in evidence before the Commission and considered in making this determination:

(a) Application to Resolve a Dispute (ARD) and attachments,

(b) Reply to ARD (Reply) and attachments, and

(c) Applications to Lodge Additional Documents.

1. The applicant completed a Bachelors degree in nursing post high school in Iran. She has since worked uninterrupted in her profession in Iran, New Zealand and then Australia. She is a very widely experienced registered nurse.
2. On 6 August 2022 the applicant went to a storage unit to collect protective material. A resident had tested positive for COVID-19. She fell as she walked into the storage unit. She initially landed on her right knee and then onto her outstretched right hand. She finally landed on her right shoulder and the right side of her body.
3. The applicant attended Dr Li and was referred for an X-ray and ultrasound of her right shoulder. She then attended Dr Manish Gupta, orthopaedic surgeon, who referred her for an MRI and treated her by way of a right shoulder arthroscopic rotator cuff repair on

22 August 2022. 4. Dr Gupta managed her care post operatively. She wore a sling for approximately 10 weeks. In the four to six week period following her surgery the applicant began to experience pins and needles and numbness in her left hand and wrist. Dr Gupta referred her for an ultrasound on her left hand and wrist. Dr Gupta diagnosed left-sided carpal tunnel syndrome and recommended left carpal tunnel decompression surgery. Liability for this surgery was denied by the insurer. 5. During this period the applicant continued to experience significant pain in her right shoulder. She had a cortisone injection which did not improve the pain significantly. 6. In January 2023 the applicant complained to Dr Li of ongoing symptoms in her right knee. He recommended an X-ray. She undertook the X-ray on 20 January 2023. 7. In late February 2023 she consulted Dr Li in regard to her right knee and was referred for an MRI which took place on 1 March 2023. She was referred to Dr Bu Balalla, an orthopaedic surgeon, for further opinion and management of her right knee pain. 8. In March 2023 the applicant again attended upon Dr Gupta who recommended a right shoulder rotator cuff repair. Liability for this surgery was denied by the insurer. 9. On 15 May 2023 Dr Balalla recommended a right total knee replacement. 10. On 29 May 2023 the applicant attended Dr Gupta for review. 11. On 6 June 2023 the insurer disputed liability for any injury to the applicant's right knee and for the proposed right knee replacement. 12. In approximately August 2024 the applicant was referred to Dr David Duckworth, orthopaedic surgeon, in relation to her right shoulder. Dr Li also referred her for an MRI of the right shoulder which she underwent in August 2024. 13. Dr Duckworth recommended a cortisone injection which the applicant underwent on

4 October 2024. The applicant continues to see Dr Duckworth for follow-up reviews every three to six months. 14. Following the applicant's fall she began to experience significant psychological symptoms of depression and anxiety. She has continued to attend upon a psychologist. 15. In January 2025 the applicant ceased physiotherapy because the insurer ceased approving payment. 16. In January 2025 the applicant was referred to see Dr Ali Gursel, a knee surgeon, for a further opinion and management. She attended Dr Gursel at her own cost on 20 January 2025. 17. The applicant continues to consult her general practitioner (GP) regularly. 18. The applicant disputes the insurer's decision to discontinue weekly payments of compensation at 130 weeks from 15 May 2025. The applicant asserts that she is totally unfit for work and is therefore eligible for continuing payments beyond 130 weeks. 19. The applicant outlined her continuing disabilities and incapacities which she alleges are extensive, in her statement.[2]

1. The applicant alleges that she had an aggravation of an asymptomatic existing degenerative arthritic condition in the right knee when she fell on 6 August 2022.
2. Dr Dias, a consultant occupational physician and Work Cover Injury Management Consultant, an Independent Medical Examiner (IME) for the applicant, provided the following opinion in relation to the applicant's right knee,

"Ms Arigni as sustained a persistent aggravation of previously asymptomatic right knee medial compartment osteoarthritis, secondary to an acute right knee soft tissue impaction injury with an associated medial meniscal tear."[3]

1. Dr Balalla stated in a report[4] to Dr Li dated 15 May 2023:

"Regarding the knee, Sedigheh has felt that there has been pain a lot of the time but was distracted by her shoulder issue. Her walking distance is diminished and it affects her sleep and ability to climb the stairs. She has been unable to return to work due to this fall.

Medial meniscus root tears are associated with rapid progression of osteoarthritis. Unfortunately treating the meniscus will have no effect. Debridement will not change her pain and repairing it I do not think is possible due to the degeneration within the meniscus. Unfortunately her only surgical option would be arthroplasty.

We have discussed total knee replacement in detail including its risks and benefits. Sedigheh feels that she would like to proceed and will seek approval from her insurer's."

1. The applicant relies on her experience of pain in her right knee following her fall. She states that she was attending to a serious and incapacitating injury to her right shoulder in the period immediately following her fall. She consulted her GP as the symptoms became apparent over time.

1. The applicant consulted Dr Gupta on 27 October 2022. At the time of this consultation the applicant was still wearing a sling on her right arm as she was in the early postoperative stage of the surgery on her right shoulder. She advised Dr Gupta that she had significant numbness and tingling affecting her left hand at night when she slept. He advised her GP,

Dr Li, that the clinical symptoms suggested a left carpal tunnel syndrome.[5]

1. Applicant's counsel submitted that the applicant is already incapacitated as a result of the injury to her right shoulder. This is supported by Dr Reiter[6] for the respondent who identifies an ongoing incapacity in the right shoulder. It is also supported by Dr Wallace in his report of 14 May 2024[7] for the respondent. He says:

"Ms Araghi's current right shoulder condition continues to be related to her work injury of 6 August 2022 with a proportion being due to pre-existing degenerative rotator cuff tear at the right shoulder."

1. The applicant also has a continuing incapacity arising from a consequent psychological condition liability for which is admitted.
2. Applicant's counsel submitted that the applicant had an existing incapacity for work arising from her shoulder into injury and consequent psychological injury without taking into account the alleged injury to her right knee and left-sided carpal tunnel syndrome. Even without consideration of the conditions that are the subject of this application the applicant is clearly totally incapacitated for work.
3. The applicant has only ever worked as a registered nurse. She is now 67 years old and is untrained for any other work. It is not credible for the respondent to suggest that she would be able to perform other duties. No real alternative employment has been suggested by the respondent. No appropriate report on this issue has been prepared on this issue and provided to the Commission.
4. The applicant's agreed PIAWE is agreed to be $2,116.32. The amount claimed as weekly compensation from 15 May 2025 being 80% of PIAWE is $1,693.05 as indexed.

1. The respondent submits that it may be inferred that, as a nurse, the applicant was aware of the importance and significance of accurate and timely record-keeping. It is therefore significant that there was no contemporaneous record of injury to the applicant's right knee on the date of injury.
2. Complaint in relation to the knee injury is contained in the report of Dr Wallace of

13 December 2022 when he noted that she had pain in her right shoulder, back and right knee. At that time there was no radiological or other examination of the knee initiated by the applicant's treating doctors. Dr Wallace did make note of any symptomatology or other examination results in relation to the knee. He opined that there was no objective medical evidence that any injury had been suffered in the fall. He observed that no investigations of the knee had taken place until March 2023, seven months post injury. He considered that the applicant suffered from degenerative osteoarthritis which was age-related and which would have been present for some years prior to the injury. Dr Wallace continued in that opinion in his subsequent reports. 3. The respondent submits that Dr Gupta referred to the applicant's right knee injury as only being likely to have been directly related to the accident. The respondent submits that his opinion is therefore not definitive. 4. The respondent submits that it is relevant to the Commissions consideration of this issue that, despite numerous attendances on Dr Li after the fall, there is no mention in Dr Li's notes of any injury to the applicant's right knee until 19 January 2023. This is five months after the fall. 5. In this case the respondent contends that the lack of contemporaneous complaints to the applicant's GP is very relevant. This is made more so by the applicant's experience in the medical profession and her inferred understanding of the importance of reports of injuries. 6. Counsel submitted;

"The respondent submits that it is improbable that the applicant would not observe and complain of 'right knee clicks', and the symptoms and/or effects of a 'Right Meniscus tear' for five months, had those symptoms/injuries have been caused by the workplace incident in August 2022. Again, this is particularly so in the circumstances where the applicant is an experienced nurse.

Accordingly, it is submitted that the precipitating factor to her right knee clicks and the 'Right Meniscus tear' is not the fall on August 2022, but the natural progression of her pre-existing degenerative pathology in the right knee, consistent with the opinion of Dr Wallace."

1. The respondent relies on the opinion of Dr Wallace in his report of 13 December 2022 [8] that the applicant's left carpal tunnel symptoms are constitutional in origin and unrelated to her employment. He relied particularly on her previous history of a right carpal tunnel syndrome which was released in 2011. He suggests this indicates that she has a congenital predisposition. He suggests she would have had left-hand symptoms about the same time or at the same time of her life had she not been working or employed with the respondent.
2. Dr Reiter, rheumatologist, was qualified to provide a report by the respondent. The respondent submitted that she was more qualified to provide an opinion as to causation than the applicant's treating doctors.
3. Dr Wallace provided the following history and findings regarding the applicant's left wrist in his report of 13 December 2022:[9]

"2 November 2022: Plain X-ray examination of the left wrist and hand shows osteoarthritis, particularly involving the 1st carpometacarpal joint. There are minor changes of joint space narrowing and bone spurring at multiple interphalangeal joints.

Ultrasound of the left wrist shows mild thickening of the median nerve at the level of the carpel tunnel.

She noted the onset of paraesthesia and numbness at her left hand without a history of further injury in mid October 2022, some 9 weeks after her work incident. She has been reviewed by Dr Gupta who has recommended operative intervention in the form of open left carpal tunnel release.

There is no causal relationship between the reported right shoulder injury on 6 August 2022 and the subsequent development of left carpal tunnel symptoms.

Ms Araghi did not note the onset of left hand symptoms until mid October 2022, some 9 weeks post-injury. There is no objective medical evidence that Ms Araghi suffered any injury at her left wrist as a result of the index fall on 6 August 2022. Ms Araghi has remained off work since 15 August 2022, some 8 weeks prior to the onset of symptoms at her left wrist.

Ms Araghi is suffering from idiopathic left carpal tunnel syndrome which is constitutional in origin and unrelated to her employment with Opal HealthCare. She has a previous history of right carpal tunnel syndrome requiring release in 2011 indicating that Ms Araghi has a congenital predisposition to this condition. Ms Araghi would have noted the onset of left hand symptoms at about the same time or at the same stage of her life had she not been at work or employed by Opal HealthCare. Her employment with Opal HealthCare is not a substantial contributing factor to her left carpal tunnel condition."

1. The applicant's PIAWE was agreed to be $2,116.32.
2. The respondent acknowledges that the applicant has an ongoing shoulder disability and a psychological component consequential upon that shoulder injury. It submits that the applicant has some residual earning capacity even though it is not significant and that regard should only be had to the restrictions emanating from the shoulder injury.
3. The respondent referred to computer training which had been undertaken by the applicant. The applicant did not consider that work to be within her capacity.
4. Dr Wallace had considered that the applicant should be upgraded to 15 hours per week realistically, with another employer.
5. Respondent's counsel noted that the applicant had had an opportunity to travel to her nieces wedding in Italy.

1. I have considered and relied on history of the onset of pain and consequent incapacity, provided by the applicant in her statement[10] which she provided to her medical practitioners.
2. The applicant's credibility has not been called into question by any submission made by the respondent. I am not persuaded that the fact that she did not raise the pain in her right knee in the immediate aftermath of the fall, but waited until her symptoms became troublesome and her right shoulder injury had been somewhat dealt with, should cause me to determine that there was no injury to the applicant's right knee on 6 August 2022.
3. Accepting the applicant's honesty, and given her work history and profession, I am persuaded that the history provided by the applicant in general, and in particular that concerning injuries to her right knee and left wrist, is reliable and should be accepted.

1. The history provided by the applicant in relation to her fall is consistent with her having sustained an injury to her right knee. When she fell, the first part of her body to hit the ground was her right knee.[11]
2. She has consistently made reference to pain in her right knee to her various treating doctors[12] including Dr Li "fall five months ago intermittent right knee pain" and "Right knee still has clickings and pain" and "Knee. Right. (Slipped and landed on the right side of body (shoulder and knee) at work in August 2022 persistent pain)".
3. She complained to Dr Gupta [13] who diagnosed a left-sided carpal tunnel syndrome.
4. The applicant also consulted Dr Balalla, orthopaedic surgeon. He records the history of injury to her right knee provided to him as follows:

"She is a registered nurse who injured herself on 6 August, 2022 while at work. She fell forward's on to her right arm and right knee. ....

Regarding the knee, Sedigheh has felt that there has been pain a lot of the time but was distracted by her shoulder issues. Prior to the injury she had no problems with her knee. She now experiences medial joint line pain. There is also significant crepitus. Her walking distance is diminished and it affects her sleep and ability to climb the stairs."

1. applicant also provided a history of injury to her right knee when she consulted

Dr Gupta, who was treating her for her right shoulder injury.[14]. 2. The applicant also noted her knee injury to the respondents IME Dr Wallace on

6 December 2022.[15] This earlier than the notification to Dr Li. He noted:

"Whilst she was in a standing position carrying a box of stock, she went to pull up her belt, lost her balance and fell to the floor impacting the lateral aspect of her right shoulder. She noted the onset of pain at her right shoulder, back and right knee. She reported the incident to her employer and was helped up by co-workers. She filled out an incident report and then made contact with the work's doctor by telephone before going home and resting."

1. I am satisfied and find that the applicant injured her right knee when she fell at the respondent's premises on 6 August 2022. I accept the evidence of the applicant's treating doctor's that the applicant's requires a total knee replacement.

1. The applicant's evidence is that she began to experience pins and needles and numbness in her left hand and wrist in the post-operative period following the right shoulder arthroscopic rotator cuff repair performed by Dr Gupta. During this period she had her right arm in a sling. She underwent an ultrasound of her left hand and wrist which demonstrated left-sided carpal tunnel syndrome.
2. The applicant reported the pins and needles in her left hand to her GP Dr Li on

1. Dr Dias, an IME for the applicant, expressed the following opinion:

"Ms Aragni suffers from consequential left-sided carpal tunnel syndrome, secondary to prolonged overcompensation as a result of her right shoulder injury, particularly in the post-operative phase from her right shoulder surgery on 6 September 2022, when

Ms Aragni's right shoulder/arm was immobilised in a sling for approximately10 weeks. Ms Aragni has suffered with ongoing symptoms and signs consistent with left-sided carpal tunnel syndrome since late 2022, as a consequence of her right shoulder condition."[17]

1. The applicant also noted left wrist pain to the respondents Dr Wallace IME on

6 December 2022.[18] In his report of 13 December 2022 he noted:

At her left hand, she notes global aching pain. The pain is worse on washing her hair, lifting overhead or at night when it wakes her up and is relieved by self massage or stretching.

She notes intermittent numbness at the tips of the fingers of the left hand, particularly with prolonged driving or holding a telephone. She notes weakness of grip at her left hand but no stiffness at her left wrist.

In the post-operative period, she was treated with sling immobilisation for 10 weeks followed by a course of physiotherapy. She is currently attending physiotherapy twice a week and again as per my previous letter it seems straightforward to understand that due to significant problems with the right upper limb related to this injury, use of medications of Panadeine and Palexia.

She noted the onset of paraesthesia and numbness at her left hand without a history of further injury in mid October 2022, some 9 weeks after her work incident. She has been reviewed by Dr Gupta who has recommended operative intervention in the form of open left carpal tunnel release."

1. Dr Gupta referred to the development of the applicant's left wrist symptoms. In his report to Dr Li of 20 March 2023 he said:

"..... I understand there is no progress on her left carpal tunnel complaint. Again as per my previous letter it seems straightforward to understand that due to significant problems with the right upper limb related to this injury, there has been the development of an overuse compression and neuropathy of the median nerve at the carpal tunnel on the left-hand. I continue to feel that this should also form part of her accepted claim."[19]

1. This opinion was repeated in a further report dated 24 March 2025.[20]
2. In a further report dated 15 January 2024 [21] Dr Gupta said:

"...regarding the left carpal tunnel syndrome, the physical examination was consistent. Ms Arigni described its onset as being related to overuse of the left-hand given her right arm was in a sling and not functional whilst convalescing from surgery. This is reasonable and appropriate."

1. Dr Gupta also remarked upon this history being consistent with her previous surgical history involving the applicant's right wrist after left shoulder surgery in the past when it was appropriately treated by surgery and physiotherapy.
2. Contrary to the opinion expressed by Dr Wallace, Dr Gupta found this previous history of carpal tunnel syndrome in the right arm to be supportive of it having been occasioned into the left-hand after a period of overuse.
3. I am satisfied and find that the applicant sustained a consequential injury to her left upper extremity (wrist) as a consequence of overuse of her left arm. This arose from having an immobilised right upper limb after surgery on her right shoulder, which was injured in her fall at the respondent's premises on 6 August 2022. I accept the evidence of the applicant's treating doctors in preference to that of Dr Reiter, that the applicant's requires a left-sided carpal tunnel surgery.

1. I am satisfied and find that the applicant is totally incapacitated for work as a result of the combined injuries sustained by her in a fall at the respondent's premises on 6 August 2022, or as a consequence thereof. Her injuries include an injury to the right upper extremity (shoulder), an injury to the right lower extremity (knee), an injury to the left upper extremity (wrist) and a psychological injury arising from the injury to the applicant's right shoulder.

1. For the reasons set out above I will make the findings and orders as set out on page 1 of the Certificate of Determination.

[1] Index and Annexures to Respondents ALAD page 2.

[2] Mansour statement of documents page 5 Paragraphs 61 to 69.

[3] Mansour statement of documents Page 73.

[4] Mansour statement of documents Page 130.

[5] Mansour statement of documents page 94.

[11] Mansour statement of documents page 2 paragraph 11.

[12] Mansour statement of documents pages150 and 151.

[13] Mansour statement of documents page 114.

[14] Mansour statement of documents page 114.

[15] Reply page 3, page 2 of report dated 13 December 2022.

[16] Mansour statement of documents page 149.

[17] Mansour statement of documents page 73.

[18] Reply page 3, page 2 of report dated 13 December 2022.

[19] Mansour statement of documents page 97.

[20] Mansour statement of documents page 112.

[21] Mansour statement of documents page 106.