austlii:nsw/NSWPIC/2025/329
General information, not legal advice.
NSWPIC
2025-07-09
Original judgment source is linked above.
(a) $1,432 per week from 27 February 2025 to 25 March 2025 under s 38(2) of the Workers Compensation Act 1987;
(b) the respondent is to make the appropriate indexation adjustments to the weekly compensation payments ordered above under s 82A of the Workers Compensation Act 1987 in accordance with the formula and review dates stipulated therein;
(c) the respondent is to be given credit for any payments made, and
(d) liberty to apply within 14 days in relation to the calculation of weekly benefits.
" ... I apologise for any miscommunication as there has not been a s 78 decision made on Barbara's claim.
A Work Capacity Decision was made on Barbara's claim in conjunction with a s 38 ineligibility decision as Barbara is not meeting the criteria. The Work Capacity Decision was withdrawn based on a calculation error.
As this was an administration error and not an error in Barbara's working capacity, the s 38 ineligibility is still correct and effective on her claim."[4]
(a) Ms Grant's pre-injury average weekly earnings (PIAWE) are $1,790, and
(b) 80% of the agreed PIAWE is $1,432.
(a) ARD dated 29 April 2025 and attached documents, and
(b) Reply to ARD (Reply) dated 21 May 2025 and attached documents
"24. The injury occurred on 11 August 2021. There was a customer in the store who was not wearing a mask. He was tall, carrying a motor bike helmet, wearing a motor cycle jacket and jeans.
"I do not believe the Certificates issued by my doctor demonstrate I have capacity to work. They were issued so that I could get some training to return to work in the future. I feel deceived by the insurer because I understand at the time they were talking to me about my return to work plans I was certified unfit for work. I was only increased to do a course."[8]
"Barbara was admitted to SDMH with left pubic rami + right radial head # + partial right common extensor tendon tear. These injuries were sustained during an assault at work, where a disgruntled customer kicked her in the back. She was admitted under the orthopaedic team and managed conservatively from fracture point of view, with APS teams involved to guide pain management and pain adequately controlled with oral analgesia. She was admitted under the inpatient rehabilitation team given her protected weightbearing status, progressing to mobilise with single point stick within a matter of days. Her confidence with mobilising and pain in general improved quickly also, with no PRN analgesia requirements required over the past 3 days. Orthopaedic teams provided discharge advice and follow up as outlined below. Unfortunately she was not able to be reviewed by inpatient psychology services during her admission, however we discussed the importance of this, suggesting regular reviews with yourself [Dr Sithara Bogoda Appuhamilage], referral for a mental health care plan and psychology input, and alternative internet and phoneline sources to use in the interim with support from local family. She was linked with the EDTT team for ongoing allied health support at home to continue with her mobility and independence goals, and discharged home in the care of her daughter on the 27th August."[9]
X-rays. She progressed to an MRI scan which revealed a lateral epicondylosis lesion and an undisplaced radial neck fracture. Dr Jarman observed that the fracture seemed stable and did not require immobilisation. He opined that the lateral epicondylosis lesion would need to be addressed later but that the present focus was Ms Grant's osseous rehabilitation.[10] 2. On 24 September 2021, Dr Jarman reported to Dr Smith that Ms Grant's elbow was functioning well. He observed that there was minimal bony tenderness with some tenderness in the region of the lateral epicondyle that may become more apparent as the use of her arm increased. He opined that she could be treated non-surgically in this regard but may require platelet rich plasma injections if the condition became problematic later. In respect of Ms Grant's pelvis, Dr Jarman was happy for her to wean off crutches after having observed her most recent X-ray. Dr Jarman noted that Ms Grant had quite an issue with post-traumatic stress disorder which warranted admission to on-campus rehabilitation. However, she received outpatient services support in this regard instead.[11] 3. On 3 November 2021, Dr Jarman reported to Dr Smith that Ms Grant was recovering well physically following her twin injuries with regard to her elbow. Essentially, she had a full range of motion. The elbow was stable and she had no bony tenderness. In respect of her pelvis, she had a full range of hip motion and no pain on weight-bearing. She was continuing to work on her pelvic stability exercises with her physiotherapist. She stated that she was making the appropriate progress with her post-traumatic stress disorder and Dr Jarman opined that this would be the limiting factor in her return to work. He recommended optimising her osteoporosis management and noted that he had not made plans to review her again.[12] 4. On 28 October 2024, Dr Smith issued Ms Grant with a Certificate of capacity certifying her as having capacity for some type of work from 22 October 2024 to 21 November 2024 for six hours per day, five days per week, noting that the factors affecting her recovery were the ongoing symptoms of post-traumatic stress disorder. However, in the comments section of the certificate, Dr Smith stated as follows:
"The patient [sic] condition has improved somewhat in that she can attend to limited social visits to beach and is attending TAFE training to work in aged care. Needs psychotherapy and report from psychologist is required."[13]
"She is having heightened traumatic and stress response to the proposal that she will not be paid by insurer as of end of Feb 2025. She cannot do a pre-injury work and do a coarse [sic] at the same time."[14]
"Patient is undergoing a TAFE course in aged care. Has some capacity for work for training purposes only."[16]
"In respect of the period 27 February 2025 to 17 April 2025, in my opinion Barbara Grant does not have any capacity for work. This is supported by her General Practitioner, who stated very clearly that her capacity is for training and study purposes only. Ms Grant is on an excellent trajectory for recovery and return to work capacity, however she is simply not ready yet. She has a clear plan for returning to work. She has absolutely no intention of staying on workcover [sic] indefinitely."[20]
"I do not agree with the work capacity decision on 18 November 2024 that Ms Grant has the capacity to work as an Aged and Disabled Carer or Clerical and Administrative Worker, 6 hours per day, 5 days per week. She has the capacity to study and train, not to work. Again, this was made extremely clear by Ms Grant's General Practitioner, Dr Trevor Smith, whose opinion should be taken in good faith as it is in the best interests of the client. Clearly Dr Smith did not know about section 38, however the certificate was made to reflect the client's needs, which are that she has zero capacity for work and some capacity to study. Moreover, Dr Smith changed the capacity only because he was directed to do so by the insurer in order to be approved to study."[21]
Associate Professor Michael Robertson: 4 April 2023
Associate Professor Michael Robertson: 15 July 2024
post-traumatic stress disorder symptoms and hypervigilance. There was no foreseeable circumstance where she could return to pre-injury duties. However, he opined that she could work in alternative duties at about 20 hours per week but that such duties should have minimum scope for interpersonal conflict or tension and have flexible timeframes for completion of tasks. The duties might have to be solitary work or work in isolated locations. He further opined:
"Given her clinical presentation, it is unlikely that Ms Grant will ever again manage to maintain gainful employment on a sustainable basis in a new occupation for which she is reasonably qualified by training, education or experience. Any future employment is likely to be on a reduced hours basis in a significantly diminished role."[27]
"A worker's entitlement to compensation in the form of weekly payments under this Part ceases on the expiry of the second entitlement period unless the worker is entitled to compensation after the second entitlement period under this section."
"A worker who is assessed by the insurer as having no current work capacity and likely to continue indefinitely to have no current work capacity is entitled to compensation after the second entitlement period."
"A worker (other than a worker with high needs) who is assessed by the insurer as having current work capacity is entitled to compensation after the second entitlement period only if -
(a) the worker has applied to the insurer in writing (in the form approved by the Authority) no earlier than 52 weeks before the end of the second entitlement period for continuation of weekly payments after the second entitlement period, and
(b) the worker has returned to work (whether in self-employment or other employment) for a period of not less than 15 hours per week and is in receipt of current weekly earnings (or current weekly earnings together with a deductible amount) of at least $155 per week, and
(c) the worker is assessed by the insurer as being, and as likely to continue indefinitely to be, incapable of undertaking further additional employment or work that would increase the worker's current weekly earnings."
'current work capacity' if the worker has a present inability arising from the injury such that the worker is able to return to the worker's pre-injury employment, or is able to return to work in suitable employment, but the weekly amount that the worker has the capacity to earn in any such employment is less than the weekly amount that the worker had the capacity to earn in that employment immediately before the injury.
'no current work capacity' if the worker has a present inability arising from an injury such that the worker is not able to return to work, either in the worker's
"'suitable employment', in relation to a worker, means employment in work for which the worker is currently suited:
(a) having regard to:
(i) the nature of the worker's incapacity and the details provided in medical information including, but not limited to, any certificate of capacity supplied by the worker (under section 44B), and
(ii) the worker's age, education, skills and work experience, and
(iii) any plan or document prepared as part of the return to work planning process, including an injury management plan under Chapter 3 of the 1998 Act, and
(iv) any occupational rehabilitation services that are being, or have been, provided to or for the worker, and
(v) such other matters as the Workers Compensation Guidelines may specify, and
(b) regardless of:
(i) whether the work or the employment is available, and
(ii) whether the work or the employment is of a type or nature that is generally available in the employment market, and
(iii) the nature of the worker's pre-injury employment, and
(iv) the worker's place of residence."
"... employment for which the worker is currently suited is determined 'regardless of' whether the work or employment is 'available' and regardless of whether it is 'of a type or nature that is generally available in the employment market'. However, other aspects of Lawarra Nominees and Woods remain relevant in determining whether a worker is 'suited' for suitable employment.[34]
However, while the new definition of suitable employment has eliminated the geographical labour market from consideration, it has not eliminated the fact that 'suitable employment' must be determined by reference to what the worker is physically (and psychologically) capable of doing, having regard to the worker's 'inability arising from an injury'. Suitable employment means 'employment in work for which the worker is currently suited' ... However, whether, under the new provisions, he or she would be found to have no current work capacity will depend on a realistic assessment of the matters listed at (a) and (b) of the definition of suitable employment. Depending on the evidence, it is difficult to see that work tasks that are totally artificial, because they have been made up in order to comply with an employer's obligations to provide suitable work under s 49 of the 1998 Act, and do not exist in any labour market in Australia, will be suitable employment."[35]
post-traumatic stress disorder caused by the work related incident. 2. On mental state examination, Associate Professor Robertson observed no inconsistencies in Ms Grant's presentation. Dr Injeti did not raise any inconsistencies in Ms Grant's presentation. Ms Carter observed that Ms Grant was extremely committed to finishing her TAFE studies, placement training and then re-entering the workforce. 3. I accept Ms Grant as a witness of truth, who did her best to provide a history of her injuries, her treatment and her complaints of symptoms to her treating doctors, psychologist and the forensic medical specialists. The histories she provided of injury, treatment and complaints of symptoms were, in the main, consistent. I also accept her unchallenged evidence, corroborated by Ms Carter, that she is motivated to return to work. 4. I accept Ms Grant's following unchallenged evidence:
(a) EML assigned Ms Grant to a rehabilitation provider, Louise of Actual Rehab to whom she expressed an interest in aged care;
(b) Dr Smith and Ms Grant were involved in a number of teleconferences with Louise of Actual Rehab, who suggested that her capacity for work be increased so that she could do the proposed TAFE course that EML would pay for;
(c) EML reimbursed Ms Grant for a police and NDIS check in order to enable her to enter the proposed 12 month TAFE course;
(d) Ms Grant commenced the TAFE course in August 2024;
(e) Ms Grant participated in the course online from home via MS Teams classes for 5.5 hours, one day per week and attended TAFE in person at Nowra once every four weeks between 9.30am and 4.30pm;
(f) Ms Grant was required to participate in three placement components to the course, being three blocks of 40 hours in November 2024, March 2025 and May 2025;
(g) Louise of Actual Rehab suggested that Dr Smith further increase Ms Grant's work capacity to enable her to attend the placement components of the course;
(h) Ms Grant participated in the first placement component of the course for a one week block in November 2024;
(i) Ms Grant participated in the second placement component of the course for a one week block beginning on 11 March 2025, and
(j) Ms Grant was not paid for her participation in the two placement components of the course.
pre-injury duties from 11 August 2021 and ongoing. 11. The next matter for consideration is whether Ms Grant was fit for suitable employment as defined in s 32A of the 1987 Act. This requires a consideration of the nature of the incapacity and the details provided in medical information, the worker's age, education, skills and work experience, any return to work plan and any occupational rehabilitation services that have been provided, irrespective of whether the work is available to her or of a type or nature that is generally available in the employment market. 12. Ms Grant is a 54-year-old woman who left high school half way through year 11 in 1987. After leaving high school, she worked for Westpac Bank for about nine years. In 1995, she left her employment with Westpac Bank to have children. When the youngest of her three children was two or three years old, she commenced work at the Abbey Nursing Home as a full-time cook for a period of about two years. She worked as a teachers' aide at the school her children attended, St George's Basin Public School, for about two years during school hours until about 2008 when funding for her position ran out. Whilst working as a teachers' aide she also worked as a cleaner at the Huskisson Bayside Motel for a period of about two years. She then obtained casual work for 20 to 30 hours per week at Coles in Vincentia for about two years. She was offered a better job at IGA in Berry in about 2014/2015 where she worked for seven to eight years. She was moved to Lyndhurst's IGA store in Bomaderry as a store manager, working six days per week, 7.5 hours per day. 13. There were no return to work plans or relevant occupational rehabilitation service reports in evidence. However, there were a series of Pinnacle Rehab reports, the first of which was dated 9 September 2021 and the last of which was dated 14 December 2021. Those early reports were of little relevance to the issue in dispute. There was the work capacity decision dated 18 November 2024 and the review request outcome dated 19 March 2025 that relied on the Actual Rehab vocational assessment report dated 12 September 2023 that purportedly suggested that suitable vocational options for Ms Grant were as an aged and disability carer or as a clerical and administrative worker. EML was satisfied that Ms Grant had the capacity to work 30 hours per week as allegedly certified by Dr Smith. It is this work capacity decision that is disputed by Ms Grant but limited to the closed period in dispute, namely, 27 February 2025 to 25 March 2025. 14. Associate Professor Robertson's most recent report dated 15 July 2024 pre-dated the closed period in dispute. However, at the time, he did provide some insight as to Ms Grant's work capacity in the future, which I have referred to at [65]-[67] above. 15. Ms Grant's consultation with Dr Injety took place about one month after the end of the closed period in dispute. However, it also provided some insight as to Ms Grant's work capacity in the future, which I have referred to at [72]-[75] above. 16. On 20 February 2025, Dr Benedicto issued Ms Grant with a Certificate of capacity certifying her as having capacity for some type of work from 20 February 2025 to 20 March 2025 for six hours per day, five days per week, noting that the factors affecting her recovery were the ongoing symptoms of post-traumatic stress disorder. The certificate also recorded that Ms Grant had fitness for some work in the form of training in aged care noting that Ms Grant was undergoing a TAFE course in aged care and had some capacity for work for training in aged care purposes only. 17. On 11 March 2025, Ms Grant commenced and completed the one week second placement component of her TAFE course. 18. On 20 March 2025, Dr Benedicto issued Ms Grant with a Certificate of capacity certifying her as having capacity for some type of work from 20 March 2025 to 17 April 2025 for six hours per day, five days per week, noting that the factors affecting her recovery were the ongoing symptoms of post-traumatic stress disorder. The certificate also recorded that Ms Grant had fitness for some work in the form of training in aged care. The certificate again recorded that Ms Grant had fitness for some work in the form of training in aged care noting that Ms Grant was undergoing a TAFE course in aged care and had some capacity for work for training purposes only. 19. On 26 March 2025, Dr Benedicto issued Ms Grant with a Certificate of capacity certifying her as having no current capacity for any work from 26 March 2025 to 9 April 2025 due to an exacerbation of her post-traumatic stress disorder. 20. In her report dated 11 April 2025, Dr Benedicto provided some clarity in respect of the certificates of capacity referred to above. She referred to the decline in Ms Grant's mental health which triggered her post-traumatic stress disorder when she was requested to return to work. This was consistent with Ms Grant's evidence that she would not be able to complete the12 month TAFE course approved by EML if she had to go back to work. Dr Benedicto opined that Ms Grant could manage work physically but that, mentally, she was not coping due to her post-traumatic stress disorder and that she required ongoing consultations with her psychologist. This was consistent with the opinions expressed by Ms Carter in her report dated 26 March 2025. 21. In respect of Ms Grant's work capacity, Ms Carter opined that Ms Grant had no work capacity during the period 27 February 2025 to 17 April 2025 and noted that such opinion was supported by her general practitioner who stated very clearly that her capacity was for training and study purposes only. Ms Carter opined that Ms Grant had capacity for study and training and had been doing remarkably well in this regard. She further opined that Ms Grant was simply not yet ready to return to work from a psychological viewpoint. 22. Ms Carter's opinion is very persuasive. Ms Grant had undergone 54 sessions of therapy with Ms Carter by the time of her report dated 26 March 2025. Ms Carter was in the best position to assess Ms Grant's psychological progress and work capacity. 23. I reject Lyndhurst's submission that there was some ambiguity in Dr Benedicto's Certificates of capacity. I am satisfied that Dr Benedicto was certifying that Ms Grant was only fit for 30 hours per week training in aged care and not fit for a return to work as such. This finding was supported by the opinion of Ms Carter. 24. I am not satisfied that the unpaid training in aged care approved by EML constitutes work that would support a finding of current work capacity. It was a pathway agreed to by EML to lead Ms Grant back to a return to work. It was a pathway she had not yet completed. Ms Grant's second onsite training component commenced on 11 March 2025 for a period of one week only. Her attendance in-person at Nowra TAFE was only required every four weeks from 9.30am to 4.30pm during the 12 month course. Course classes were online from home for 5.5 hours, one day per week. 25. I am not satisfied that being able to study and train in aged care for the hours set out above meant that Ms Grant had a current work capacity during the closed period in dispute in the light of Dr Benedicto's evidence and more particularly, the evidence of Ms Carter. There was no persuasive medical evidence in Lyndhurst's case that expressed an opinion in respect of the closed period of weekly benefits claimed. Further, the Actual Rehab vocational assessment report relied on by Lyndhurst in its work capacity decision was not in evidence. 26. Having regard to the medical evidence of Dr Benedicto and particularly, Ms Carter as to Ms Grant's capacity, Ms Grant's age, skills, work experience and the other relevant factors to be considered in accordance with s 32A of the 1987 Act, I am satisfied, on the balance of probabilities, that she had no current work capacity during the period in dispute, namely, 27 February 2025 to 25 March 2025. 27. Accordingly, I find that Ms Grant is entitled to weekly compensation from 27 February 2025 to 25 March 2025 at the agreed rate of $1,432 per week under s 38(2) of the 1987 Act.
[1] Application to Resolve a Dispute at pages 7-11.
[2] Application to Resolve a Dispute at pages 12-16.
[3] Application to Resolve a Dispute at pages 17-22.
[4] Application to Resolve a Dispute at page 23.
[29] Wollongong Nursing Home Pty Ltd v Dewar [2014] NSWWCCPD 55.
[30] Sabanayagam v St George Bank Ltd [2016] NSWCA 145.
[31] Sabanayagam v St George Bank Ltd [2016] NSWCA 145 at [127].
[32] Arnott's Snack Products Pty Ltd v Yacob [1985] HCA 2; 155 CLR 171.
[33] Mid North Coast Local Health District v De Boer [2013] NSWWCCPD 41.
[34] Wollongong Nursing Home Pty Ltd v Dewar [2014] NSWWCCPD 55 at [56].
[35] Wollongong Nursing Home Pty Ltd v Dewar [2014] NSWWCCPD 55 at [57]- [60].
Grant
Lyndhurst IGA Pty Ltd [2025] NSWPIC 329;