Damages
68 The plaintiff was born in Lebanon on 21 January 1978. He came to Australia for the first time as a child, after his father sought work here, but the family returned to Lebanon and the plaintiff completed his schooling there to year 11. He then undertook a course in Beirut, obtaining a certificate in air conditioning and he became fluent in English, French and Arabic. Then in 1996 he returned to Australia, where he unsuccessfully sought a position as an apprentice electrician. He worked in a chicken shop for a short time and then he worked as a tradesman's assistant with Caltex for a short period. Thereafter he obtained the position which took him to the premises of BHP.
69 The plaintiff said that when he fell he injured his lower back at the top of the left buttock. He also injured his left arm and his right knee. He said that his left arm became swollen and he experienced much pain. He was taken to hospital, first to the John Hunter Hospital and then to Royal Newcastle Hospital. He said that he was detained in hospital for one day and one night. He was discharged with his left arm in plaster. On 10 October 1996 the plaintiff attended the Orthopaedic Clinic at Royal Newcastle Hospital where the plaster was removed for x-rays. These revealed a comminuted fracture of the left radial head with small pieces of bone displaced anteriorly . A fracture of the lunate bone in the left wrist was detected. A short arm plaster of Paris was reapplied to the left forearm. The plaintiff was not seen again at the hospital after 15 October 1996, at which time it was noted that the left arm was comfortable.
70 The plaintiff gave evidence that pain persisted in the buttock, in the right knee and in the left upper limb. He also described bruising to the left side of his chest and to the left thigh after his fall. His evidence was that he was seen by Dr Youssef, by Dr Siddiqui, by Dr Meakin and by Dr Guirgis. In 1997 the plaintiff said that he underwent physiotherapy treatment and in the years since then he says that he has experienced persisting pain in the left upper limb and in the back. He said that sometimes the back pain radiates to the left leg.
71 According to the plaintiff, he has continued to take medication in the form of pain killers and anti-inflammatory medication and this has been prescribed by a local doctor who, as I understand the plaintiff's evidence, the plaintiff has been seeing regularly over the years. That general practitioner is Dr Jaam. No report has been forthcoming from Dr Jaam.
72 The plaintiff gave evidence that he has been depressed, but he said that in this regard he has improved in recent months.
73 The plaintiff is a married man with two young children.
74 The plaintiff has done little by way of work since his fall in October 1996. He said that within a short time after the accident he returned to work on light duties, doing supervisory work at the front of the site. However, this did not last long and he was sent home. He said:
"My boss told me 'You cannot stay here. It is illegal for you to stay with the plaster.'"
75 The plaintiff said that a few months later he approached the first defendant for light work but the application was unsuccessful, and eventually he received a letter from the first defendant, dated 25 November 1997, advising of the termination of his services.
76 The plaintiff said that he undertook a computer course in September and October 1997 and he then underwent a period of rehabilitation, during which there was some attempt to find work as a console operator at a petrol station. That attempt was unsuccessful. The plaintiff said that he has also sought work as a shop assistant, but I must say that the plaintiff's evidence left me with the impression that his efforts to find work over the past seven years have not been intensive. For instance, he acknowledged in cross examination that he did not try to obtain work in the year 2000 and he said that that was due to "my shortcoming". Dr Jaam said he was unfit throughout 2001, so the plaintiff was not seeking work then. According to the plaintiff he has not tried himself directly to obtain work as a console operator.
77 The plaintiff kept a record of his applications for positions, (Exhibit H), and as I understand his evidence he was required to do so by the workers' compensation insurer. The plaintiff said he was looking for work with restricted hours and it was in 2002 that he first thought of seeking work of the type which he is now undertaking. From the beginning of August 2003 the plaintiff has had paid employment of a clerical nature in an accountant's office at Lakemba. He works three hours per day and is paid $169 per week gross. What the future holds in that employment is uncertain. The plaintiff said that three hours per day is as much as he can cope with because of pain in the left upper limb, and he also said that his back hurts if he sits for too long.
78 In assessing the significance of the injuries which the plaintiff suffered and any persisting disabilities, it is necessary, of course, to heed the medical evidence in this case. All such evidence has been presented in report form only, even though there are a number of doctors who have reported that they consider the plaintiff has been exaggerating.
79 The plaintiff has relied principally upon Dr Deveridge who saw the plaintiff in June 1999, in October 2002 and in May 2003. According to Dr Deveridge there has been little change in the plaintiff's position over the past four years. In June 1999 Dr Deveridge summarised the plaintiff's injuries as follows:
"1. Comminuted intraarticular fractures of the left elbow and left wrist joints - ongoing joint pain, stiffness, weakness, loss of function and dexterity.
2. Soft tissue injury to the left sacroiliac joint and lumbar spine - ongoing low back and proximal left leg pain and stiffness.
Impact type injury to right knee joint which may have damaged the medial meniscus - ongoing knee joint pain and stiffness."
80 On 22 May 2003 Dr Deveridge reported:
"There has been no material change in your client's condition since I last examined him. He continues to suffer from post fracture aches, pains, stiffness in the left elbow and left wrist joint, with consequent loss of strength and dexterity.
His low back pain is due to a chronic strain injury involving the left sacroiliac joint and to a lesser extent his lower lumbar spine.
He has sustained soft tissue injury to both knee joints, more on the right side where he may have a mild derangement."
81 I observe that the plaintiff has been complaining about neck problems which Dr Deveridge opined to be related to the fall but that claim is not pressed by the plaintiff, and in any event I am not persuaded, looking at all the medical evidence, that the neck pain which came on a significant period after the fall was in any way related to it.
82 So far as capacity for work is concerned, as long ago as 3 June 1999 Dr Deveridge expressed the opinion that the plaintiff was unfit for all work for a period not exceeding six months and that thereafter he had a restricted capacity for work. Dr Deveridge said this in June 1999:
"He should avoid forceful, sustained and repetitive stress on the left hand, wrist and forearm. This will include heavy lifting, pushing, dragging and twisting actions. The back disability will restrict him from frequent bending, lifting, twisting and prolonged periods of fixed spinal posture. The knee joint injuries will result in minor restrictions, such as jumping, climbing, very frequent kneeling and crouching. However in light of his overall disability and restrictions, he is going to find difficulty returning to the work place. He requires further rehabilitation and retraining in order to find a light manual or sedentary type job."
83 Reviewing the plaintiff's position in October 2002, Dr Deveridge regarded the plaintiff then as having "reached a point of maximal medical improvement" and in May 2003 he wrote:
"He remains fit for limited and light physical work. The left elbow and wrist joints reasonably restrict him from heavy lifting, pushing, dragging and twisting actions with this limb. The neck, back and knee injuries have minor restrictions on repetitive bending, heavy lifting, awkward leg positions and prolonged periods of fixed spinal posture. He is in need of further rehabilitation and retraining, following which there would be reasonable prospects for him to return to the workforce."
84 Dr Guirgis saw the plaintiff on 21 August 1997 and again in February 1998. In the view of Dr Guirgis on 23 September 1997 the position was as follows:
"The above accident resulted in the following injuries:
1. Post-traumatic symptoms in the left elbow following the healing of fractures of the head of the radius and coronoid process of the ulna that were treated conservatively. There was isotope scan evidence of early post-traumatic osteoarthritic changes within the elbow joint.
2. Post-traumatic symptoms in the left wrist following the healing of fractures of the left lunate and of the distal end of the left radius that were treated conservatively. Again there was isotope scan evidence of early post-traumatic osteoarthritic changes within the left radio-carpal articulation.
3. An injury to the left sacro-iliac joint and to the lumbar area of the spine in the form of musculo-ligamentous sprain\strain. In view of that MRI scans were arranged for further evaluation of the current situation. Such studies are safe to perform, have a high index of accuracy and in my opinion the most cost-effective investigatory tool available to help plan further management and predict a prognosis. This injury was treated conservatively. Surgical treatment is not indicated.
The patient remains unfit for activities that would require applying stresses to the spine or left arm."
85 Dr Meakin assessed the plaintiff in February 1997 when he noted that the plaintiff's main discomfort was associated with his left elbow joint where he lacked ten degrees of extension. Dr Meakin noted also that the plaintiff's lumbar back pain was decreasing at that time and that the plaintiff was looking for selected working duties "which I am sure he will cope with."
86 The plaintiff tendered reports from a general practitioner, Dr Siddiqui, from a physiotherapist, Mr Sawan, and from a psychological consultant, Onsy Mattar. I do not propose to record any of the content of those reports.
87 Dr Preston is a specialist physician who saw the plaintiff for the first defendant in February 2001. I quote from the doctor's report:
" OPINION: Mr George is a 23 year old man who had a fall at work in 1996. Following this incident, he sustained demonstrated fractures at the left elbow and left wrist. He also reports low back pain since the time of the fall. No demonstrated pathology has been found on available imaging. His symptoms are most localised to the left lumbo-sacral facet joints.
I think he has referrable symptoms to the left leg from the lumbar spine. I did not find any significant demonstrable pathology within the left or right knees on examination. Though he does have some neck pain, I think this is unrelated to his fall and note that there was an 8-9 month interval between his fall and onset of his neck symptoms.
ATTITUDE : It is noted on examination that the sensory disturbance reported within the left upper limb does not have a clear anatomical basis.
FITNESS : In view of ongoing symptoms, particularly in the low back, it is unlikely Mr. George will be able to return to heavy labouring work. He will be able to do sedentary duties provided he was able to vary his posture and alternate between sitting and standing positions.
He should avoid any heavy lifting or repetitive bending."
88 Dr Preston considered that the complaints referable to the left wrist, the left elbow and the low back were linked to the fall at work and that it was likely that the plaintiff would continue to experience discomfort in the left elbow and in the left wrist where he may develop arthritic changes. Dr Preston found it difficult to determine the likely cause of the low back pain.
89 Dr Scarf made an assessment of the plaintiff in 2001. He observed in relation to the left upper limb that joints were involved in the various fractures and that there was some restricted movement in the left elbow and tenderness in the left wrist. Apart from those sites. Dr Scarf found that there was little on examination by way of clinical evidence of continuing pathology, and Dr Scarf thought that the plaintiff was fit to resume work, stating
"He would be fit to work at a bench, in light stores or spare parts area. He should avoid any strain on his left wrist or elbow. Fortunately he is right handed and therefore any inability to fully supinate his left hand is not likely to get into trouble."
90 Dr Scarf considered the prognosis for the left elbow and wrist to be uncertain in that the plaintiff "may develop some post traumatic degenerative changes at an accelerated rate".
91 Dr Chen, a consultant in occupational medicine, assessed the plaintiff in September and October 2002. Dr Chen found that the fracture of the left elbow had healed with ten percent restriction in supination and that the left wrist fracture had united leaving residual tenderness around the site of the fracture. Dr Chen observed that there was no evidence to indicate significant pathology in the lumbar spine, and it was her opinion that the plaintiff was fit at the time of assessment for full time work, avoiding repetitive heavy forceful gripping with the left hand. In Dr Chen's view, work of the nature carried out at BHP was unsuitable, but suitable alternative work
"would include work as a store person and in retail as a sales assistant. In a factory environment, he could work as a process worker, machine operator and factory hand. He could also work as a cleaner. In terms of previous work for which he has experience, he would be fit to work as a general hand in a chicken shop, cooking and selling chicken."
92 I referred earlier to medical opinions that the plaintiff was exaggerating. Dr Muratore made an assessment in September 2002 stating that the plaintiff has
"global chronic pain which I believe is tinged with exaggeration and embellishment.
It is possible he has minor osteoarthritic change at the left elbow and left wrist joints. This should not prevent him from gainful employment.
In my opinion, he is fit for his pre-injury duties if he were willing to undertake these but it is unlikely we will convince this gentleman to return to any form of employment in the foreseeable future."
93 Earlier, Dr Lee, consultant psychiatrist, made an assessment of the plaintiff in August 2000 and concluded that there was "a significant chance he is exaggerating his symptoms". Dr Lee did not consider the plaintiff had any psychiatric disorder.
94 Dr White assessed the plaintiff in November 2002, recording that the plaintiff has "continued to complain of a litany of physically unexplained pain." He said that the plaintiff's presentation during his interview with him
"verged on the absurd. He stood up, sat down, moved the chair, sat cross legged on the floor, slouched on the chair, sat cross legged against the wall, and generally put his entire body through a wide range of movements with no plausible pain behaviour."
95 In Dr White's view the plaintiff had no psychiatric disorder and any disability was a matter for orthopaedic assessment.
96 Medical evidence was tendered by the second defendant as Exhibit 5. I propose only to refer to the report of Dr Silva and the report of Dr Bornstein. Each of these two reports follow very recent medical assessments.
97 Dr Silva is an orthopaedic surgeon and he examined the plaintiff on 22 July 2003. Dr Silva found that the plaintiff lacked the last five degrees of flexion and the last five degrees of extension in the left elbow and supination of the left forearm was limited to three-quarters of the normal range. There was limitation of flexion in the left wrist and also some limitation of extension. Examination of the back was relatively unremarkable. Dr Silva concluded that the plaintiff had some symptoms in the left elbow and in the left wrist and over the left buttock, although he noted that the plaintiff freely admitted that the low back was better. The plaintiff also had some symptoms in the neck, but as to this no claim is made that these are referable to the fall at work.
98 In Dr Silva's opinion at the time he saw no significant difficulty for the plaintiff in doing the duties of a tradesman's assistant or his duties as a clerk or a messenger boy on a full time basis. Dr Silva considered the plaintiff's prognosis to be reasonably good, although the plaintiff might require the occasional analgesic for his residual symptoms. The plaintiff will not require any physiotherapy or orthopaedic operations.
99 Dr Bornstein is another orthopaedic specialist who made an assessment of the plaintiff on 23 July 2003. He examined the plaintiff's back and found the examination to be "entirely normal". When he examined the plaintiff's knees there was no evidence of crepitus, no wasting in the thighs or calves and no effusion in either joint. There was no evidence of internal derangement within the knees. Dr Bornstein found slight loss of dorsiflexion in the left wrist but other ranges of movement were "reasonably full". Dr Bornstein found the ranges at the elbow to be full.
100 Dr Bornstein's conclusions in relation to the left upper limb were that the complaints of pain in the left elbow and of crepitus and of occasional locking in the elbow were consistent with the injuries he had suffered. Dr Bornstein did not find the plaintiff to have any abnormality in his lower back. In Dr Bornstein's opinion the plaintiff may require removal of loose bodies in the left elbow, but there was no further treatment he could be offered for his left wrist. In Dr Bornstein's opinion, the plaintiff, who is right handed, is fit for clerical type work and other office work.
101 Assessment of the extent of the plaintiff's disabilities has to be undertaken without my having had the benefit of hearing any of the medical specialists. I approach my assessment of the plaintiff with some caution, particularly since I do not consider the plaintiff has used his best endeavours in the past to find work within his capacity. I am satisfied however that the plaintiff suffered significant injuries to his left wrist and to his left elbow. I am also satisfied that he injured his low back, but that the injury did not involve disc damage. Symptoms and restrictions referable to the back injury have gradually settled down. Having regard in particular to the most recent orthopaedic assessments undertaken by Dr Silva and by Dr Bornstein, I am not satisfied that the plaintiff has any ongoing disability in the back such as would prevent him from engaging in his pre injury work. Nevertheless, the plaintiff has a problem of some significance in the left upper limb that would prevent him from doing the heaviest forms of activity. Fortunately the plaintiff is right handed. I shall return to consider the plaintiff's work capacity past, present and future shortly.
102 Because the assessment of damages as against the first defendant is governed by the Workers' Compensation Act and the assessment of damages as against the second defendant is not so governed, it will be necessary for me to make two assessments.
103 I first assess damages as against the first defendant.
104 The first element in this assessment is an award pursuant to s 151G of the statute. Mr Nock submitted, particularly having regard to the injuries to the left upper limb, that the injuries sustained by the plaintiff should be categorised as extremely serious. Both Mr McIntyre and Mr Windsor joined issue with that submission. For the purposes of s 151G Mr Nock submitted that it would be appropriate to assess this case as calling for a proportion of thirty-five to forty percent of the maximum amount that may be awarded for non economic loss. On the other hand, both Mr McIntyre and Mr Windsor submitted that an appropriate proportion was of the order of twenty percent. Whilst I do not accept that the plaintiff's injuries should be categorised as extremely serious, I must bear in mind that the plaintiff was a very young man when he was injured and he still has the prospect of a long life before him. The injury to the left upper limb was a very significant one and it seems to me that it is appropriate to award this plaintiff twenty-five percent of the maximum amount under s 151G. I therefore assess damages for non economic loss in the sum of $55,412.50.
105 The statute precludes an allowance of interest on any part of that sum.
106 It has been submitted on behalf of the plaintiff that a substantial allowance is warranted for past economic loss. The plaintiff was working twelve hour shifts and on the basis of such shifts six days per week was earning $804.62 per week. It was submitted that he ought to be treated as having been totally incapacitated until June 1999, and that his loss for this period is $108,784 at his pre-accident rate. Thereafter, it was submitted, he should be regarded as having an ability to earn but $200 per week-odd, and his loss on this basis from June 1999 to date has been calculated at $134,160. This approach to the claim for past economic loss would call for an assessment under this heading of $242,944. I do not accept that such an approach would be appropriate.
107 Contrary to the claim advanced by the plaintiff in respect of the past, Mr McIntyre, for the first defendant, submitted that the plaintiff has been fit for a wide range of work since early 1997 since which time his lost capacity has been measurable at a figure between $100 and $200 per week. Mr Windsor submitted that that more modest approach overstated the measure of the lost capacity. Recording these competing submissions emphasises the very real and difficult issue which loss of earning capacity presents in this case.
108 I accept that the plaintiff's injuries were totally incapacitating for at least six months and that thereafter the plaintiff required rehabilitation and retraining to equip him to return to work. Unfortunately, as previously recorded, the first defendant offered him no work after he was sent away from the workplace with his limb in plaster. The plaintiff had some physiotherapy in July 1997 and he began, but did not complete, a computer course in September 1997. He said that it was at the end of 1997 that he started rehabilitation, and as to this he gave the following evidence (T13-14):
"Q. At this stage you had started some rehabilitation, is that right?
A. Yeah, in the end of 1997 I started rehabilitation.