PROCEDURE BEFORE THE PERSONAL INJURY COMMISSION

1. At a conciliation/arbitration hearing (the hearing), conducted by MS Teams on

1 December 2025, Mr Josh Beran, counsel, appeared on behalf of the applicant, instructed by Walker Law Group. Mr Robin Young, solicitor of Holman Webb Lawyers appeared on behalf of the respondent. 2. I am satisfied that the parties to the dispute understand the nature of the application and the legal implications of any assertion made in the information supplied. I have 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 have been unable to reach an agreed resolution of the dispute.

1. The parties agreed that the following issue remains in dispute:

(a) whether the various claimed treatment is reasonably necessary treatment as a result of the injuries, and the extent and quantification of the applicant's entitlement to payment of medical and related expenses pursuant to s 60 of the 1987 Act.

1. No application for leave to cross-examine was made and no oral evidence was given.

1. The following documents were in evidence before the Commission and considered in making this determination:

(a) Application to Resolve a Dispute (ARD);

(b) Reply to ARD;

(c) Application to Lodge Additional Documents (ALAD), dated 16 October 2025, filed by applicant;

(d) ALAD dated 26 October 2025, filed by respondent, and

(e) ALAD dated 27 October 2025, filed by applicant.

1. The applicant provided evidence by way of six statements, respectively dated 18 May 2023, 25 August 2023, 11 October 2024, 2 February 2025, 9 September 2025 and

(a) detailed the history of the accepted injuries following him falling into a drain at his workplace on 8 March 2022, relevant treatment and his claims for workers compensation;

(b) stated that he suffers from persistent ongoing pain, symptoms and disabilities as a result of the accepted injuries;

(c) described weight gain and sleep difficulties that he experienced since his sustained the accepted injuries;

(d) stated that on or around 18 April 2023, he underwent a corticosteroid injection into his lumbar spine, although he did not have a good outcome from that injection and experienced urinary issues;

(e) stated that he was referred to Dr Hsu and has been under his care in relation to the accepted back injury since around November 2023;

(f) stated that in December 2023 Dr Sandroussi recommended that he undergo weight loss surgery and that Dr Frieberg initially diagnosed a potential sleep disorder and recommended that the applicant undergo a full diagnostic polysomnogram to provide an accurate diagnosis;

(g) in September 2025, stated that Dr Friberg diagnosed severe chronic insomnia and severe obstructive sleep apnoea as a result of the accepted injuries;

(h) stated that at the request of the respondent's insurer, on 15 January 2025, he underwent an examination by Dr Dimitri in relation to his sleep condition, however the insurer refused to release Dr Dimitri's report;

(i) stated that he was referred to Dr Howison, ear nose and throat specialist, in relation to obstructive sleep apnoea;

(j) stated that Dr Hsu recommended he undergo a further corticosteroid injection into his lumbar spine as an alternative to more aggressive treatment such as surgery;

(k) stated that he has now been cleared, from a urological perspective, to continue treatment for the accepted back injury;

(l) stated that he wishes to fully ventilate all conservative treatments for the accepted back injury before considering more serious treatment options;

(m) in September 2025, stated that whilst he initially sustained a lot of weight gain following the accepted injuries because of functional limitations, he has since experienced significant fluctuations in his weight as he worked to lose weight as his doctors told him that would help with recovery and rehabilitation of the accepted injuries;

(n) stated that in April 2025, upon the recommendation of Dr Sandroussi, he commenced taking Tirzepatide medication to assist with weight loss;

(o) stated that Tirzepatide medication has been effective to assist with weight loss and that since taking the medication, he has been able to drop his weight from around 138kg to 99kg;

(p) stated he would like to continue with the ongoing treatment plan recommended by Dr Sandroussi to help improve his symptoms and rehabilitation from the accepted injuries, and

(q) in November 2025, described the circumstances of him whipper-snippering on

16 September 2025 and lawnmowing on 17 September 2025, which was depicted in surveillance videos, and explained that since losing approximately 40kg he has been able to complete more activities, although it is still painful and that he was required to take pain-killer medication and to pace himself to complete those tasks.

(a) a surveillance report dated 16 October 2025, and

(b) surveillance videos which depict the applicant undertaking activities including whipper-snippering on 16 September 2025 and lawnmowing on

17 September 2025.

1. A Vocational Assessment Report dated 30 August 2022 reported on the assessment of the applicant's ability to return to pre-injury duties and employability in alternative employment options.

1. The treating medical evidence includes various reports and clinical notes, including:

(a) clinical records of:

(i) Tamworth Hospital on various dates between February 2015 and September 2022;

(ii) Barton Lane Practice;

(iii) The Belmore Surgery;

(iv) Workers Doctors;

(b) various WorkCover Certificates, and

(c) medication prescriptions, pharmacy receipts and table of past expenses.

1. The treating medical evidence demonstrates the following relevant medical history, which I accept:

(a) the applicant underwent various imaging of his spine and knees prior to the accepted right knee injury;

(b) on 24 August 2018, a CT scan of the lumbar spine was reported to show an essentially normal study;

(c) on 10 September 2021, Dr John Swan of Tamworth Orthopaedic Clinic, reported that the applicant was overweight and walked with an antalgic gait and had notable valgus deformity of both of his lower limbs. Dr Swan reported that the applicant had patella femoral instability certainly on the right side, had increased tibial external torsion and had significant valgus of both knees, which may be contributing to patella instability symptoms and possible dislocations;

(d) on 26 October 2021, Dr Keith Landale of Tamworth Orthopaedic Clinic, reported that the applicant continued to describe ongoing mechanical knee symptoms and that MRI and X-rays confirmed a loose osteochondral fragment in the anterior portion of the joint, loosening of the MPFL in keeping with a sprain, and bony oedema in keeping with recurrent dislocation symptoms to the lateral femoral condyle;

(e) on 8 March 2022, the applicant was treated at Tamworth Hospital Emergency Department for pain to his right knee following him sustaining the accepted right knee injury;

(f) the applicant underwent various imaging of his right knee between March and October 2022;

(g) the applicant was referred to Dr Max Leibenson, orthopaedic surgeon, in relation to right knee dysfunction, who reported on the applicant's right knee symptoms, investigation and treatment of the accepted right knee injury in various reports dated from 23 March 2022 and 6 July 2022. Dr Liebenson reported that the applicant had a constitutional bilateral valgus knee alignment and a laterally tracking patella and pre-existing right knee lateral compartment degenerative changes and a loose osteochondral fragment causing recurrent mechanical symptoms in the right knee. Dr Liebenson expressed the opinion that the accepted right knee injury was the main contributing factor to the exacerbation of pre-existing right knee large osteochondral fragment and discrete degenerative changes in the lateral compartment of the right knee. Dr Liebenson expressed the opinion that the applicant would require right knee arthroscopy to remove the osteochondral fragment and chondroplasty to mitigate his symptoms;

(h) on or about 22 June 2022, the applicant underwent arthroscopic surgery of his right knee, performed by Dr Liebenson, with the objective of removing a large loose body in his right knee joint that had been causing significant ongoing symptoms. However, the surgery failed;

(i) on 27 June 2022, the applicant was treated at Tamworth Hospital Emergency Department for ongoing right knee pain post arthroscopy;

(j) from 9 to 12 July 2022, the applicant was admitted to Tamworth Hospital for review and treatment of increasing right knee pain and symptoms post arthroscopy;

(k) on 13 July 2022, an MRI right knee was reported to show: large cartilage defect weight bearing left lateral femoral condyle with 12mm osteochondral bone fragment immediately posteriorly; and two loose bodies posterior to the posterior cruciate ligament measuring 6mm and 5mm respectively;

(l) on 19 August 2022, Dr Ben Gooden, orthopaedic surgeon, reviewed the applicant and recommended the applicant did not undergo further arthroscopic surgery to explore the right knee for the misplaced loose body. Dr Gooden noted that the applicant was likely to have ongoing issues with his right knee and recommended that the applicant engage with a physiotherapist;

(m) on 6 September 2022, the applicant was treated at Tamworth Hospital Emergency Department for right knee contusion, pain and swelling following a fall;

(n) on 9 September 2022, an MRI right knee was reported to show: large area of cartilage loss weight bearing lateral femoral condyle unchanged; previously noted 12mm osteochondral bone fragment posteriorly no longer visualised; two loose bodies persist posterior to the posterior cruciate ligament; effusion and ganglion of popliteus tendon sheath; and mild patellar tendinopathy unchanged;

(o) on 12 September 2022, Dr Jim Stacey, orthopaedic surgeon, reported to the insurer that he did not believe that the applicant's ongoing right knee symptoms were related to the accepted right knee injury;

(p) on 10 October 2022, an MRI right knee was reported to show unchanged imaging appearance;

(q) on 13 October 2022, an MRI lumbar spine was reported to show a L4/5 right focal foraminal disc protrusion contacting the exiting right L4 nerve root;

(r) on 13 October 2022, Dr Gooden acknowledged that the applicant had a number of episodes of his right knee giving out, and he recommended conservative treatment;

(s) the applicant came under the general medical follow-up care of Dr Eric Lim, general practitioner;

(t) on 3 November 2022, Dr Lim, reported that the applicant had symptoms which included lower back pain radiating down his bilateral legs, bilateral knee pain, trouble sleeping, fatigue and he currently weighed 130kg. Dr Lim reported that the applicant's symptoms related to the accepted right knee injury and back injury. Dr Lim recommended a management plan which included weight management and pain medication;

(u) the applicant was referred to Dr Brian Hsu, neurosurgeon, on account of significant exacerbation of his back condition and potential radicular symptoms in the right lower limb;

(v) in April 2023, the applicant was seen by Dr Brian Hsu, neurosurgeon, who recommended a CT-guided injection into the lumbar spine;

(w) on 18 April 2023, the applicant underwent a CT-guided injection into the lumbar spine, performed by Dr Hsu, however the applicant did not experience any improvement in his back or right leg symptoms, and was in severe pain after the injection and subsequently experienced urinary incontinence;

(x) on 17 November 2023, Dr Hsu reviewed the applicant and recommended that he undergo a urological assessment to determent whether there was a possible nexus between the accepted back injury and the urinary incontinence;

(y) the applicant was referred to Dr Charbel Sandroussi, gastroenterologist, in relation to the urinary symptoms. On 12 December 2023, Dr Charbel Sandroussi, gastroenterologist, reported on the applicant's condition and noted that the applicant had gained a significant amount of weight as a consequence of his immobility and medications that he was taking for his symptoms. Dr Sandroussi recommended that the applicant undergo weight reduction surgery to assist his physical rehabilitation;

(z) the applicant was also referred to Dr David Freiberg, consultant physician respiratory and sleep medicine. On 12 December 2023, Dr Frieberg reported that he diagnosed that the applicant had three potential sleep disorders; firstly, insomnia due to pain; secondly, periodic limb movement disorder due to nerve root injury in his back; and thirdly, sleep disordered breathing. Dr Frieberg reported that the applicant's sleep apnoea and some of his sleeping disorders were affected by worsening weight gain and the need to sleep on the side or supine position, rather than the prone position which is protective to airway obstruction. Dr Frieberg stated that as a consequence, the applicant has developed moderately sever hypersomnolence which affects multiple aspects of his health;

(aa) on 8 February 2024, Dr Eric Lim, general practitioner, reported that as a result of the accepted injuries, the applicant struggled with constant back and knee pain and had gained approximately 20kg and as a result of that weight gain he had developed a sleep disorder which required further investigation;

(bb) on 26 April 2024, Dr David Frieberg, consultant physician respiratory and sleep medicine, reported that the applicant had three potential sleep disorders, consistent with his previous report. Dr Frieberg expressed the opinion that the applicant's severe insomnia due to pain and potential significant sleep disordered breathing were exacerbated by the accepted injuries. Dr Frieberg stated that no treatment had been recommended for the applicant because the applicant had not undergone the appropriate diagnostic investigation of a polysomnogram, which was not a treatment intervention, but which may lead to treatment recommendations such as respiratory support devices at night or pharmacological intervention for periodic limb movement disorder. Dr Frieberg stated that, should the applicant require CPAP therapy, that had level one evidence that it can be 100% effective when used regularly and the treatment would be recommended to the applicant. Dr Frieberg recommended that the applicant undergo a diagnostic polysomnogram, at a cost in accordance with the recommended fee for a BF015;

(cc) on 24 May 2024, Dr Paul Tawadros, general practitioner, reported that the applicant had chronic back and knee pain and dysfunction;

(dd) on 18 July 2024, Dr Tang of Patrick St Medical Centre, injury management consultant, reported on a file review of the applicant's file. Dr Tang expressed opinions regarding the management of the applicant's WorkCover claims however he did not provide any detailed basis for his opinions;

(ee) on 2 September 2024, Dr Lim reported that the applicant continued to struggle with constant back and knee pain and dysfunction as a result of the accepted injuries which affected his ability to work. Dr Lim reported that as a result of the accepted injuries, the applicant had gained 20kg and developed a sleep disorder. Dr Lim stated that the applicant's sleep specialist, Dr David Frieberg, had identified hat the applicant was suffering from insomnia and periodic limb movement disorder due to nerve root injury in his lower back. Dr Lim also stated that Dr Charbel Sandroussi, surgeon, had recommended that the applicant undergo weight loss surgery to alleviate the consequences of his weight gain;

(ff) on 9 January 2025, Dr Carbel Sandroussi, gastroenterologist, reported that when he reviewed the applicant on 12 December 2023, his BMI was around 41 and he came for a discussion about weight loss surgery following significant weight gain. Dr Sandroussi expressed the opinion that the applicant's weight was multifactorial and had mostly been a consequence of the accepted injuries, including poor mobility, pain relief and other medications which increased his appetite. Dr Sandroussi recommended that the applicant undergo surgical weight loss treatment, at a cost in the order of $25,000 to $30,000, to improve the applicant's weight and also his symptoms from the accepted injuries;

(gg) on 15 January 2025, Dr Morgan Mo requested MRI lumbar spine for updated imaging for flare-up of back pain after the accepted injuries, noting L4/5 disc pathology on previous imaging (ARD 310);

(hh) on 24 January 2025, MRI lumbar spine was reported to show: discopathy at the L4-5 level; segmentation anomaly with a vestigial disc at the L5-S1 level (which was essentially a variation of normal); the L4-5 disc has lost signal and a little bit of height and bulges slightly anterior; no modic endplate changes, ie. bone marrow oedema changes, that would indicate severe degeneration that would warrant surgical intervention; no nerve compression and no evidence of instability;

(ii) on 25 February 2025, MRI right knee was reported to show: severe lateral compartment degenerative disease with meniscal tear; and loss of cartilage and subchondral bone marrow;

(jj) on 20 February 2025, Dr Sushama Deshpande, interventional pain specialist, reported that the applicant presented with left knee and lower back pain issues following the accepted injuries. Dr Deshpande stated that he recommended right knee MRI and bone scan examination;

(kk) on 26 February 2025, Nuclear medicine bone scan with CT-SPECT was reported to show: no increased uptake in the lumbar spine; some anomalies in the sacroiliac joints (but within normal limits); no evidence of significant sacroiliac joint dysfunction;

(ll) on 20 March 2025, the applicant underwent a diagnostic sleep study upon referral by Dr Frieberg;

(mm) on 2 April 2025, Dr David Frieberg, consultant physician respiratory and sleep medicine, reported that the applicant had undergone a diagnostic polysomnogram which showed that he suffers severe chronic insomnia and severe obstructive sleep apnoea. Dr Frieberg provided a detailed explanation for his opinion of the likely cause of those conditions. Dr Frieberg explained that chronic pain may have precipitated the applicant's chronic insomnia and, once it was chronic, it evolves into a neurological mediated disorder, sustained by central nervous system dysfunction. Dr Frieberg explained that the mechanism of the severe obstructive sleep disorder is an exacerbation of a pre-existing predisposition due to type 1 obesity and moderate tonsillar enlargement exacerbated by positional change from the prone to the non-prone sleep position as well as 16% increase in total body weight. Dr Frieberg stated that the applicant clearly requires treatment intervention for the sleep disordered breathing.

Dr Frieberg recommended CPAP to improve the breathing and to benefit sleep quality which can mitigate insomnia symptoms and sleep disturbances;

(nn) on 17 April 2025, Dr Carbel Sandroussi, gastroenterologist, reported that the applicant had lost about 10kg and now weighed about 124 kg as a result of dietary changes. Dr Sandroussi reported that the applicant was not keen on weight loss surgery and had been started on a GLP-1 inhibitor;

(oo) on 8 May 2025, Dr Sushama Deshpande, interventional pain specialist, reported that osteoarthritis identified on an MRI dated 25 February 2025 was secondary to the accepted right knee injury trauma and the surgical intervention that was done to address that injury;

(pp) on 16 May 2025, the applicant underwent a CPAP titration sleep study and a report detailed the results of the study;

(qq) on 26 May 2025, Dr David Frieberg, consultant physician respiratory and sleep medicine, reported on the applicant's treatment intervention sleep study and stated that it showed that there would be significant benefit to the applicant to his severe sleep apnoea with CPAP and the Dr Frieberg had approached the applicant's insurer to approve the introduction of CPAP in the home environment;

(rr) on 30 May 2025, A/Prof Timothy Steel, consultant neurosurgeon and spine surgeon, reported on the recent imaging. A/Prof Steel reported that the majority of the applicant's low back pain was almost certainly arising from the gait disturbance as a result of his right knee and that the L4-5 disc shows mild discopathy but the changes are not significant enough to warrant surgery at the present time. A/Prof Stell stated that alleviating the applicant's knee issues would likely help his back pain. A/Prof Steel noted that it had been recommended that the applicant undergo cortisone injection in the knee with a view to performing a radiofrequency lesioning. However, A/Prof Steel did not recommend any neuroablative treatment and stated that whist a cortisone injection in the knee would be an option, it could not treat the majority of the applicant's pain which was arising from the subchondral bone marrow. A/Prof Steel suggested that the applicant start oral Pregnisone in the short course and Meloxicam medication. A/Prof Steel did not recommend any surgical intervention in the management of the applicant's lumbar spine. A/Prof Steel recommended that the applicant continued weight loss, noting that his weight had already reduced from 138kg to 115kg;

(ss) on 30 June 2025, Nominated Treating Specialist Dr Brian Hsu, orthopaedic surgeon requested consultation and CT guided epidural and steroid injection L5-S1 to treat the applicant's back and leg pain;

(tt) in a report dated 4 July 2025, Dr David Frieberg, consultant physician respiratory and sleep medicine, noted differing records of the applicant's weight at various times however stated that they did not substantially alter his view. Dr Frieberg stated that, even if the applicant's pre-injury BMI was 38, his progression to 133 kg (BMI 41) after the injury still represents a further 8% gain in total body weight, and more importantly, it is clear from the applicant's history and the pattern on sleep study that the real precipitant of the applicant's sleep apnoea was the enforced change in sleep position due to his back and knee pain. Dr Frieberg stated that, prior to the applicant's injury he consistently slept prone - a position well known to protect the upper airway - however, pain had since forced him to sleep on his side or back, substantially increasing airway collapsibility.

Dr Frieberg also noted that the isolated pre-injury GP note about not sleeping does not demonstrate a pre-existing insomnia disorder, noting that there is no indication in the medical records of chronic sleep difficulties, no pattern of hypersomnolence, and no investigations such as sleep studies until well after the accepted injuries. Dr Frieberg expressed the opinion that the proposed treatment of CPAP therapy for obstructive sleep apnoea together with continued sleep physician oversight, is reasonably necessary as a direct consequence of the accepted injuries. Dr Frieberg noted that the accepted injuries set off a cascade of events, causing persistent spinal and knee pain which forced a shift in the applicant's sleeping posture from prone to predominantly side and back, which removed a critical anatomical protection against airway collapse and, in conjunction with notable weight gain caused by reduced physical activity, directly contributed to the emergence of severe positional OS, which was confirmed by polysomnogram showing an RDI of 87/hour supine. Dr Frieberg stated that, in addition, the pain initiated a pattern of fragmented sleep, and over time, what began as insomnia secondary to pain has become a chronic neurological condition marked by hyperarousal and sustained disruption of sleep regulation, noting a well-documented connection between chronic pain and insomnia.

Dr Frieberg stated that CPAP therapy, which typically costs around $2,500 to set up and $200 to $300 per annum in running costs, is reasonably necessary treatment to treat the applicant's severe obstructive sleep apnoea. Dr Frieberg stated that fluctuations in the applicant's weight did not alter his opinion in that regard, noting that the accepted injuries directly precipitated the applicant's sleep disorder now requiring CPAP because it forced him to adopt side and back sleeping, which is well known to exacerbate pharyngeal obstruction, particularly when compounded by weight gain. Dr Frieberg continued to recommend CPAP therapy and ongoing specialist oversight as the cornerstone of the management of the applicant's severe obstructive sleep apnoea;

(uu) on 25 August 2025, the applicant was treated at Tamworth Hospital Emergency Department for acute on chronic lower back pain;

(vv) on 26 August 2025, Dr Morgan Mo requested MRI lumbar spine for updated imaging for flare-up of back pain after the accepted injuries, noting L4/5 disc pathology on previous imaging (ARD 317), and

(ww) on 18 September 2025, Dr Brian Hsu, spine surgeon, reported that the applicant reported that he sustained the accepted injuries as a result of him falling into a drain in the workplace in March 2022. Dr Hsu reported that he was unaware of any pre-existing injuries, conditions or pre-disposing factors prior to the accepted injuries. Dr Hsu stated that the applicant's symptoms correlate with the findings on examination and the injuries sustained. On that basis, Dr Hsu opined that the accepted injuries were the substantial contributing factor to the applicant's condition. Dr Hsu stated that the applicant continues to experience symptoms relevant to the accepted back injury.

Dr Alan Hopcroft, general surgeon, independent medical expert qualified by the insurer

(a) reported the history of the accepted injuries, diagnosed the accepted right knee injury being an aggravation of a pre-existing condition, and noted that the applicant was to undergo arthroscope of his right knee to remove a loose body in the knee, and

(b) noted that the applicant required a weight reduction program.

1. In a report dated 20 September 2022, Dr Hopcroft:

(a) reported that the arthroscopy to remove a loose body in the applicant's right knee had failed, and that the applicant continued to suffer from deteriorating function of his right knee joint and that the pathology remained essentially unchanged;

(b) expressed the opinion that in the accepted injury, a large fragment detached from the lateral femoral condyle and is now causing intermittent obstruction with his right knee joint movements, and that it was a combination of constitutional changes causing a genu valgus deformity and subluxing knee caps and the accepted injury, and

(c) recommended that the applicant undergo a follow-up arthroscopy to remove loose bodies in his right knee joint.

Dr Peter Endrey-Walder, general and trauma surgeon

1. In a report dated 8 December 2022, Dr Endrey-Walder:

(a) reported the history, investigations and treatment of the accepted injuries;

(b) in respect of the accepted right knee injury, diagnosed significant aggravation and exacerbation to the applicant's right knee;

(c) in respect of the accepted back injury, stated that the accepted right knee injury would likely have cause injury to the applicant's lower back with more recent aggravation of the applicant's lower back condition likely to be related to his abnormal gait;

(d) stated that MRI scan suggested possible nerve root compression causing sciatic type pain at the L4/5 level, and noted that the applicant was awaiting consultation with Dr Lim, neurosurgeon, and

(e) stated that the applicant was completely unfit for any kind of work activity at that stage and in the foreseeable future.

1. In a report dated 21 August 2024, Dr Endrey-Walder:

(a) recorded that the applicant reported ongoing pain and symptoms in his right knee and lower back and that his left knee was also starting to hurt because it was overcompensating for the right knee;

(b) on examination, recorded that the applicant weighed 130kg;

(c) in relation to the accepted right knee injury, diagnosed an aggravation and exacerbation of long-standing pre-existing pathology;

(d) in relation to the accepted back injury, diagnosed significant aggravation and exacerbation of lower back condition, precipitating right sided L4-5 disc protrusion causing sciatica, and

(e) expressed the opinion that the applicant had no capacity for employment and recommended that he undergo sustained physical therapy.

Dr Assad Saboor, psychiatrist, independent medical expert qualified by the applicant

(a) recorded a history of the accepted injuries;

(b) recorded that the applicant reported that he weighed about 132kg and that he had gained 30kg of weight since he sustained the accepted injuries;

(c) recorded that the applicant reported constant body aches and pains, and

(d) diagnosed major depressive illness with anxiety features as a result of the accepted injuries.

Dr Robert Kaplan, forensic psychiatrist, independent medical expert qualified by the insurer

(a) recorded a history of the accepted injuries;

(b) recorded that the applicant reported ongoing symptoms dominated by pain and accompanying restrictions;

(c) diagnosed pain disorder (somatic symptom disorder), adjustment disorder with depression and anxiety secondary to pain disorder, both being secondary to the accepted injuries (in addition to pre-existing personality disorder and attention deficit hyperactivity disorder), and

(d) recommended that the applicant undergo a comprehensive pain management program and see a psychiatrist for review of medication.

Dr John Bentivoglio, orthopaedic surgeon, independent medical expert qualified by the insurer

1. In a report dated 25 August 2023, Dr Bentivoglio:

(a) recorded a history of the accepted injuries;

(b) in respect of the applicant's right knee, diagnosed constitutional degenerative change involving the lateral compartment of his knee together with constitutional dislocation of his right patella, noting that the applicant had pre-existing loose bodies present in his knee from his osteochondritis dissecans. Dr Bentivoglio expressed the opinion that the damage seen in the applicant's right knee related to pre-existing conditions, and the specific incident at work on 8 March 2022 would only have caused short -term aggravation to that pre-existing condition.

Dr Bentivoglio did not consider that any of the applicant's right knee disabilities related to the applicant's work;

(c) in respect of the applicant's back, diagnosed discal damage in L4/5 of his lumbar spine. Dr Bentivoglio expressed the opinion that the applicant's back condition does relate to the specific injury of 8 March 2022, and was not an aggravation of a pre-existing incident. Dr Bentivoglio accepted that the applicant had permanent weakness at the L4/5 level of his lumbar spine caused by the jarring injury to his back at work on 8 March 2022 and that he will have ongoing indefinite intermittent symptoms in his back, and

(d) in relation to the applicant's left knee, diagnosed patellofemoral instability caused by genetic predisposition to patellar dislocations. Dr Bentivoglio expressed the opinion that the applicant's left knee condition was entirely constitutional in origin and that the applicant does not have a consequential condition of his left knee caused by the accepted right knee injury. Dr Bentivoglio did not consider that any of the applicant's left knee disabilities related to the applicant's work.

1. In a report dated 19 December 2024, Dr Bentivoglio:

(a) recorded a history of the accepted injuries;

(b) expressed the opinion that all of the discal damage at the L4/5 level of the applicant's spine was caused by the work incident on 8 March 2022, and

(c) expressed the opinion that none of the applicant's knee complaints relate to that work incident, but instead all relate back to pre-existing abnormalities.

1. In a report dated 21 November 2025, Dr Bentivoglio:

(a) expressed the opinion that the applicant does not need any treatment at all for his accepted right knee injury and accepted left knee injury on the basis that all of his treatment needs relate to the applicant's pre-existing abnormalities;

(b) stated that the applicant did previously undergo an appropriate CT-guided cortisone injection, which made his symptoms worse, and that he is unsure of the outcome of the applicant subsequently seeing a urologist in that regard;

(c) stated that the surveillance video did not demonstrate that the applicant was having any symptoms or disability relevant to his knees and back, with the exception that it depicted that he had significant valgus malalignment present in both knees and he wore a soft support brace for his right knee;

(d) expressed the opinion that the accepted right knee injury and the accepted left knee injury would have totally resolved by no later than 1 May 2022 and that any of the applicant's ongoing complaints following that time relates to his significant pre-existing abnormalities, and

(e) expressed that opinion that the accepted back injury does continue to be a substantial contributing factor to the applicant's back incapacity, noting that he does have permanent weakness at the L4/5 level of his lumbar spine, which presumably arose from the accepted back injury.

1. The applicant's counsel's submissions were made orally during the hearing and were recorded. The respondent's counsel's submissions and the applicant's counsel's submissions in reply were made in writing. I have considered all the submissions in full and I am grateful to counsel for their assistance in this matter.

1. Section 60 of the 1987 Act relevantly provides:

"60 Compensation for cost of medical or hospital treatment and rehabilitation etc

(1) If, as a result of an injury received by a worker, it is reasonably necessary that:

(a) any medical or related treatment (other than domestic assistance) be given, or

(b) any hospital treatment be given, or

(c) any ambulance service be provided, or

(d) any workplace rehabilitation service be provided,

the worker's employer is liable to pay, in addition to any other compensation under this Act, the cost of that treatment or service and the related travel expenses specified in subsection (2)."

1. Burke CCJ in Rose v Health Commission (NSW),[2] stated:

"...Treatment is necessarily purposive. Treatment, in the medical or therapeutic context, relates to the management of disease, illness or injury by the provision of medication, surgery or other medical service designed to arrest or abate the progress of the condition or to alleviate, cure or remedy the condition. It is the provision of such services for the purpose of limiting the deleterious effects of a condition and restoring health. If the particular 'treatment' cannot, in reason, be found to have that purpose or be competent to achieve that purpose, then it is certainly not reasonable treatment of the condition and is really not treatment at all. In that sense, an employer can only be liable for the cost of reasonable treatment..." (my emphasis)

1. In Diab v NRMA Ltd,[3] Roche DP, referring to the decision in Rose v Health Commission (NSW),[4] set out the test for determining if medical treatment is reasonably necessary as a result of a work injury_:_

"The standard test adopted in determining if medical treatment is reasonably necessary as a result of a work injury is that stated by Burke CCJ in Rose v Health Commission (NSW) [1986] NSWCC2; [1986] NSWCC 2; (1986) 2 NSWCCR 32 (Rose) where his Honour said, at 48A-C:

1. Any necessity for relevant treatment results from the injury where its purpose and potential effect is to alleviate the consequences of injury.
2. It is reasonably necessary that such treatment be afforded a worker if this Court concludes, exercising prudence, sound judgment and good sense, that it is so. That involves the Court in deciding, on the facts as it finds them, that the particular treatment is essential to, should be afforded to, and should not be forborne by, the worker.
3. In so deciding, the Court will have regard to medical opinion as to the relevance and appropriateness of the particular treatment, any available alternative treatment, the cost factor, the actual or potential effectiveness of the treatment and tis place in the usual medical armoury of treatments for the particular condition."
4. Roche DP also noted that the Commission has generally referred to and applied the decision of Burke CCJ in Bartolo v Western Sydney Area Health Service:[5]

"The question is should the patient have this treatment or not. If it is better that he have it, then it is necessary and should not be forborne. If in reason it should be said that the patient should not do without this treatment, then it satisfies the test of being reasonably necessary."

"In the context of s 60 the relevant matters, according to the criteria of reasonableness, include, but are not necessarily limited to, the matters noted by Burke CCJ at point (5) in Rose (see [76] above), namely:

(b) the appropriateness of the particular treatment;

(c) the availability of alternative treatment, and its potential effectiveness;

(d) the cost of the treatment;

(e) the actual or potential effectiveness of the treatment, and

(f) the acceptance by medical experts of the treatment as being appropriate and likely to be effective.

With respect to point (d), it should be noted that while the effectiveness of the treatment is relevant to whether the treatment was reasonably necessary, it is certainly not determinative. The evidence may show that the same outcome could be achieved by a different treatment, but at a much lower cost. Similarly, bearing in mind that all treatment, especially surgery, carries a risk of a less than ideal result, a poor outcome does not necessarily mean that the treatment was not reasonably necessary. As always, each case will depend on its facts."

Is the treatment reasonably necessary as a result of injury?

1. A commonsense evaluation of the causal chain is required. The applicable legal test of causation was set out by the Court of Appeal in Kooragang,[6] where Kirby P (as his Honour then was) stated:

"From the earliest days of compensation legislation, it has been recognised that causation is not always direct and immediate...

Since that time, it has been well recognised in this jurisdiction that an injury can set in train a series of events. If the chain is unbroken and provides the relevant causative explanation of the incapacity or death from which the claim comes, it will be open to the Compensation Court to award compensation under the Act."[7]

"The result of the cases is that each case where causation is in issue in a workers' compensation claim, must be determined on its own facts. Whether death or incapacity results from a relevant work injury is a question of fact. The importation of notions of proximate cause by the use of the phrase 'results from', is not now accepted. By the same token, the mere proof that certain events occurred which predisposed a worker to subsequent injury or death, will not, of itself, be sufficient to establish that such incapacity or death 'results from' a work injury. What is required is a commonsense evaluation of the causal chain. As the early cases demonstrate, the mere passage of time between a work incident and subsequent incapacity or death, is not determinative of the entitlement to compensation. In each case, the question whether the incapacity or death 'results from' the impugned work injury (or in the event of a disease, the relevant aggravation of the disease), is a question of fact to be determined on the basis of the evidence, including, where applicable, expert opinions. Applying the second principle which Hart and Honoré identify, a point will sometimes be reached where the link in the chain of causation becomes so attenuated that, for legal purposes, it will be held that the causative connection has been snapped. This may be explained in terms of the happening of a novus actus. Or it may be explained in terms of want of sufficient connection. But in each case, the judge deciding the matter, will do well to return, as McHugh JA advised, to the statutory formula and to ask the question whether the disputed incapacity or death 'resulted from' the work injury which is impugned."

1. Although the High Court in Comcare v Martin[8] raised some concerns about the commonsense evaluation of the causal chain in a matter that concerned Commonwealth legislation, the commonsense approach still has place in the application of the legislation to the present case.
2. The work injury does not have to be the only, or even a substantial, cause of the need for the relevant treatment before the cost of that treatment is recoverable under s 60 of the 1987 Act - it is only necessary to establish that the injury materially contributed to the need for the treatment. In Murphy v Allity Management Services Pty Ltd,[9] Roche DP stated at [57] and [58] that:

"57. The work injury does not have to be the only, or even a substantial, cause of the need for the relevant treatment before the cost of that treatment is recoverable under s 60 of the 1987 Act.

1. Ms Murphy only has to establish, applying the commonsense test of causation (Kooragang Cement Pty Ltd v Bates (1994) 35 NSWLR 452; 10 NSWCCR 796), that the treatment is reasonably necessary "as a result of" the injury (see Taxis Combined Services (Victoria) Pty Ltd v Schokman [2014] NSWWCCPD 18 at [40] - [55]). That is, she has to establish that the injury materially contributed to the need for the surgery (see the discussion on the test of causation in Sutherland Shire Council v Baltica General Insurance Co Ltd (1996) 12 NSWCCR 716)."
2. It is not necessary for the applicant to establish that a consequential condition is itself an 'injury' pursuant to s 4 of the 1987 Act nor that the employment was a substantial contributing factor within the meaning of s 9A of the 1987 Act. In Moon v Conmah Pty Ltd,[10] Deputy President Roche stated at [45]-[46]:[11]

"It is therefore not necessary for Mr Moon to establish that he suffered an 'injury' to his left shoulder within the meaning of that term in section 4 of the 1987 Act. All he has to establish is that the symptoms and restrictions in his left shoulder have resulted from his right shoulder injury. Therefore, to the extent that the Arbitrator and Dr Huntsdale approached the matter on the basis that Mr Moon had to establish that he sustained an 'injury' to his left shoulder in the course of his employment with Conmah they asked the wrong question."

1. In Bouchmouni v Bakhos Matta t/as Western Red Services,[12] Deputy President Roche stated:

"The Commission has considered and explained the difference between an 'injury' and a condition that has resulted from an injury in several recent decisions...

The injury to Mr Bouchmouni's right knee caused him to seek treatment in the form of surgery and physiotherapy. The evidence suggests that it was in the course of receiving that treatment, and/or as a result of an altered gait because of his knee symptoms, Mr Bouchmouni developed back symptoms. If that is accepted, and no reason has been advanced why it should not be, it is clear beyond doubt that his back condition has resulted from the treatment he received for his accepted knee injury and his altered gait. That does not, however, make the back condition an 'injury'."

1. In North Coast Area Health Service v Felstead (Felstead),[13] Roche DP observed at [81]:

"81. It follows that the description of a personal injury as 'a sudden identifiable pathological change' is consistent with the authorities. It suggests no more than that, to qualify as a personal injury, there must be some sudden and ascertainable or dramatic physiological change or disturbance of the normal physiological state. Such a change or disturbance may be as simple as a bruise or a soft tissue strain. If the personal injury also aggravates a pre-existing disease, that does not mean it is no longer a personal injury."

1. The Court of Appeal in Nguyen v Cosmopolitan Homes[14] held that a tribunal of fact must be actually persuaded of the occurrence or existence of the fact before it can be found, and stated:

"(1) A finding that a fact exists (or existed) requires that the evidence induce, in the mind of the fact-finder, an actual persuasion that the fact does (or at the relevant time did) exist;

(2) Where on the whole of the evidence such a feeling of actual persuasion is induced, so that the fact-finder finds that the probabilities of the fact's existence are greater than the possibilities of its non-existence, the burden of proof on the balance of probabilities may be satisfied;

(3) Where circumstantial evidence is relied upon, it is not in general necessary that all reasonably hypotheses consistent with the non-existence of a fact, or inconsistent with its existence, be excluded before the fact can be found, and

(4) A rational choice between competing hypotheses, informed by a sense of actual persuasion in favour of the choice made, will support a finding, on the balance of probabilities, as to the existence of the fact in issue."

1. For convenience, I will address the evidence and submissions in the manner addressed by counsel, having regard to the various categories of treatments claimed by the applicant.

1. The applicant claims the expenses of past weight loss treatment as follows:

(a) 29 April 2025 Mounjaro Kwikpen 2.5MG/0.6ML $279.99 (ARD 320);

(b) 21 May 2025 Mounjaro Kwikpen 2.5MG/0.6ML $279.99 (ARD 321);

(c) 25 June 2025 BD Ultrafine Pen 31G $5.99 (ARD 322);

(d) 25 June 2025 Mounjaro Kwikpen 7.5MG/0.6ML $539.99 (ARD 323);

(e) 22 July 2025 BD Ultrafine Pen 31G $5.99 (ARD 324);

(f) 22 July 2025 Mounjaro Kwikpen 7.5MG/0.6ML $539.99 (ARD 325);

(g) 14 August 2025 Mounjaro Kwikpen 10MG/0.6ML $539.99 (ARD 328), and

(h) 14 August 2025 BD Ultrafine Pen 31G $5.99 (ARD 328).

1. A critical issue which I am required to determine is whether the applicant sustained significant weight gain (consequential weight gain) as a result of the accepted injuries.
2. The evidence indicates that the applicant's weight from time to time was as follows:

(a) Dr Frieberg recorded a pre-injury weight of 115kg and a BMI of 36 (ARD 256);

(b) on 23 March 2022, the applicant was recorded as having a BMI of 38 (ARD 201);

(c) on 27 April 2022, around two months after the applicant the accepted injuries, he weighed 126kg (ARD 99, 102);

(d) on 16 September 2022, Dr Matthew Nguyen recorded that the applicant had gained 12 kg (ARD 351);

(e) on 20 September 2022, Dr Hopcroft recorded that the applicant's weight had increased from 126kg to 132kg in the six-month period following the accepted injuries (ARD 109);

(f) on 3 November 2022, the applicant weighed 130kg (ARD 230);

(g) on 5 April 2023, the applicant weighed 132kg and had a BMI of 43.1 (respondent's ALAD 26. 27);

(h) on 6 October 2023, the applicant weighed 137kg and stated that he had gained 20kg to 30kg since he sustained the accepted injuries (ARD 424);

(i) on 12 December 2023, the applicant weighed 133kg and had a BMI of 41 (ARD 240, 241);

(j) on 7 February 2024, the applicant weighed 132.6 kg (respondent AALD 26);

(k) on 2 September 2024, the applicant weighed 133kg (ARD 236);

(l) on 18 December 2024, the applicant weighed 125kg (Reply 17);

(m) on 20 March 2025, the applicant weighed 133kg and had a BMI of 41 (ARD 261, 262);

(n) on 5 April 2025, the applicant weighed 132kg (respondent AALD 26);

(o) on 17 April 2025, Dr Charbel Sandroussi provided the applicant with a prescription for Trizepatide (ARD 318);

(p) after starting in Trizepatide, on 17 May 2025, the applicant weighed 124 kg (ARD 249);

(q) on 30 May 2025, the applicant weighed 115kg (ARD 282);

(r) on 10 September 2025, the applicant weighed 102kg (respondent AALD 26);

(s) on 24 October 2025, the applicant weighed 97.9kg (respondent AALD 26), and

(t) in his statement dated 26 November 2025 (the applicant's second AALD), the applicant stated that he has lost approximately 40kg.

1. I note that on 12 December 2023, Dr Charbel Sandroussi, gastroenterologist, reported that the applicant had gained a significant amount of weight as a consequence of his immobility and medications that he was taking for his symptoms. At that time, Dr Sandroussi recommended that the applicant undergo weight reduction surgery to assist his physical rehabilitation.
2. On 9 January 2025, Dr Carbel Sandroussi, gastroenterologist, reported that when he reviewed the applicant on 12 December 2023, his BMI was around 41 and he came for a discussion about weight loss surgery following significant weight gain. Dr Sandroussi expressed the opinion that the applicant's weight was multifactorial and had mostly been a consequence of the accepted injuries, including poor mobility, pain relief and other medications which increased his appetite.
3. It is apparent from the evidence that the respondent did gain weight after he sustained the accepted injuries. Subsequently, the applicant's weight fluctuated somewhat until about April 2025, from which time he then lost a substantial amount of weight and now currently weighs less than he did at the time he sustained the accepted injuries.
4. In relation to alternative treatments, I note that Dr Sandroussi initially recommended that the applicant undergo surgical weight loss treatment, at a cost in the order of $25,000 to $30,000, to improve the applicant's weight and also his symptoms from the accepted injuries. However, the applicant was reluctant to undergo such surgery.
5. As noted above, ultimately in April 2025, Dr Sandroussi prescribed Trizepatide to assist the applicant to lose weight. The above evidence indicates the effectiveness of Trizepatide to assist the applicant to lose weight.
6. The applicant's evidence and the medical evidence as a whole indicates the substantial symptoms and disabilities that the applicant has suffered as a consequence of the accepted injuries. Considering the evidence as I whole, I consider that it is logical and likely, and I accept that, as a result of the accepted injuries, the applicant did suffer a loss of mobility.
7. Having regard to the applicant's evidence and the medical evidence, I also accept that the applicant was required to take various pain medications to address his symptoms, some of which may cause weight gain.
8. On that basis, I consider that it is logical and likely, consistent with the evidence of

Dr Sandroussi which I accept, that the applicant sustained weight gain as a result of the accepted injuries, although it did fluctuate somewhat, and since commencing Trizepatide in April 2025 has since lost weight to below his pre-injury weight. 9. Further, considering the evidence as a whole, I consider that it is logical and likely, and I accept, that it was reasonably necessary for the applicant to address his post-injury weight gain and to lose weight to assist with rehabilitation of his injuries. Further, I consider that it is logical and likely, as suggested by Dr Frieberg consultant physician respiratory and sleep medicine, that the applicant's weight gain was a significant exacerbating factor to development of his chronic insomnia and severe obstructive sleep apnoea. 10. For the above reasons, I find the opinions of Dr Frieberg and Dr Sandroussi to be particularly persuasive as they provide a logical and well-reasoned explanation for the applicant's weight gain and the use of Trizepatide to address it. Having regard to the evidence as a whole, I am satisfied that Trizepatide was effective to address the applicant's weight gain. The cost of Trizepatide has not been challenged by the respondent. The only alternative treatment identified was weight loss surgery, which was at a significantly greater cost and which carried risks inherent with any such surgery. 11. On that basis, I accept that it was reasonably necessary to address the applicant's weight gain by use of Trizepatide. 12. I accept that Trizepatide is reasonably necessary treatment as a result of the accepted injuries, pursuant to s 60 of the 1987 Act.

1. The applicant claims the expenses of future sleep treatment as follows:

(a) consultation with Dr Kenneth Howison, ENT as referred by Dr Morgan Mo (ARD 314) at the gazetted rate;

(b) ongoing CPAP therapy, and

(c) continued sleep position oversight.

1. A critical issue which I am required to determine is whether the applicant sustained a sleep disorder (consequential sleep conditions) as a result of the accepted injuries.
2. The applicant's treating consultant physician respiratory and sleep medicine, Dr David Frieberg, gave evidence by way of a number of reports.
3. There is a clinical record of the applicant's treating general practitioner which indicates that the applicant reported not sleeping pre-injury. However, Dr Frieberg, opined that such isolated clinical record not sleeping does not demonstrate a pre-existing insomnia disorder, correctly noting that there is no other indication in the medical records of chronic sleep difficulties, no pattern of hypersomnolence, and no investigations such as sleep studies until well after the applicant sustained the accepted injuries.
4. In March 2025, the applicant underwent a diagnostic polysomnogram which was reported to show that he suffers severe chronic insomnia and severe obstructive sleep apnoea.
5. Dr Frieberg opined that the accepted injuries directly precipitated the applicant's sleep disorder.
6. Dr Frieberg provided a detailed explanation for his opinion of the likely cause of the applicant's chronic sleep difficulties. Specifically, Dr Frieberg reasoned that the accepted injuries set off a cascade of events, causing persistent spinal and knee pain which forced a shift in the applicant's sleeping posture from prone to predominantly side and back, which removed a critical anatomical protection against airway collapse and, in conjunction with notable weight gain caused by reduced physical activity, directly contributed to the emergence of severe positional obstructive sleep apnoea, which was confirmed by polysomnogram.
7. Dr Frieberg explained that whilst chronic pain likely precipitated the applicant's chronic insomnia, once it was chronic, it evolved into a neurological mediated disorder, sustained by central nervous system dysfunction. Dr Frieberg stated that the pain initiated a pattern of fragmented sleep, and over time, what began as insomnia secondary to pain has become a chronic neurological condition marked by hyperarousal and sustained disruption of sleep regulation, noting a well-documented connection between chronic pain and insomnia.
8. Dr Frieberg explained that the mechanism of the severe obstructive sleep disorder is an exacerbation of a pre-existing predisposition due to type 1 obesity and moderate tonsillar enlargement exacerbated by positional change from the prone to the non-prone sleep position as well as increase in the applicant's total body weight subsequent to him sustaining the accepted injuries.
9. As noted above, I accept that the applicant sustained significant weight gain as a result of the accepted injuries.
10. Dr Frieberg stated that evidence of fluctuations in the applicant's weight did not alter his opinion in that regard, Dr Frieberg stated that, even if the applicant's pre-injury BMI was 38, his progression to 133 kg (BMI 41) after the injury still represents a further 8% gain in total body weight.
11. In any event, Dr Frieberg stated that, more importantly, it is clear from the applicant's history and the pattern on sleep study, that the real precipitant of the applicant's sleep apnoea was the enforced change in sleep position due to his back and knee pain, noting that, prior to the accepted injuries, the applicant consistently slept prone - a position well known to protect the upper airway - however, pain had since forced him to sleep on his side or back, substantially increasing airway collapsibility.
12. Dr Frieberg stated that the applicant clearly requires treatment intervention for the sleep disordered breathing.
13. In May 2025, Dr Frieberg reported that the applicant underwent a CPAP titration sleep study which showed that there would be significant benefit to the applicant to his severe sleep apnoea with CPAP in the home environment.
14. Dr Frieberg expressed the opinion that the proposed treatment of CPAP therapy for obstructive sleep apnoea together with continued sleep physician oversight, is reasonably necessary, as a direct consequence of the accepted injuries, to improve the applicant's sleep disordered breathing and to benefit sleep quality which can mitigate insomnia symptoms and sleep disturbances.
15. Dr Frieberg stated that CPAP therapy, which typically costs around $2,500 to set up and $200 to $300 per annum in running costs, is reasonably necessary treatment to treat the applicant's severe obstructive sleep apnoea.
16. The respondent has not challenged the claimed costs for treatment of the applicant's sleep conditions.
17. I found that Dr Frieberg's evidence and opinion to be well reasoned and compelling. As the applicant's treating sleep specialist, I consider that Dr Frieberg would have a good understanding of the applicant's clinical condition and needs.
18. Considering the evidence as a whole, I am satisfied that Dr Frieberg's evidence provides a logical and likely explanation for the applicant's sleep conditions which was identified by the diagnostic sleep study and the need for the requested treatment.
19. I note that there is no compelling evidence of any suitable alternative treatments to address the applicant's sleep conditions.
20. On that basis, I accept that the applicant has consequential sleep conditions identified by

Dr Frieberg and that it is reasonably necessary as a result of the accepted injuries, to address the consequential sleep conditions by the treatment requested. 21. Accordingly, I accept that the following are reasonably necessary future treatments as a result of the accepted injuries, pursuant to s 60 of the 1987 Act:

(a) consultation with Dr Kenneth Howison, ENT as referred by Dr Morgan Mo (ARD 314) at the gazetted rate;

(b) ongoing CPAP therapy, and

(c) continued sleep position oversight.

1. The applicant claims the expenses of past pain treatment as follows:

(a) 22 July 2025 Meloxicam 15MG $6.90 (ARD 325), and

(b) 25 August 2025 Oxycodone IR (Mayne) 5MG $6.90 (ARD 329).

1. The applicant claims the expenses of future pain treatment as follows:

(a) MRI LUMBAR SPINE as recommended by Dr Morgan Mo on 15 January 2025 (ARD 310) and 26 August 2025 (ARD 317) at the gazetted rate;

(b) ongoing consultations with nominated treating specialist Dr Brian Hsu, orthopaedic surgeon as referred by Dr Morgan Mo on 20 May 2025 (ARD 313) at the gazetted rates;

(c) consultation and CT guided epidural and steroid injection L5-S1 as recommended by Dr Brian Hsu on 30 June 2025 (ARD 316) at the gazetted rate, and

(d) right genicular nerve blocks to address right knee pain as recommended by

Dr Sushama Deshpande (ARD.311) at the gazetted rates.

1. The applicant's evidence and the medical evidence, as a whole, consistently demonstrates that the applicant has experienced ongoing symptoms including chronic pain as a result of the accepted injuries.
2. The applicant was ultimately referred to Dr Sushama Deshpande, interventional pain specialist, to treat his chronic pain.
3. The respondent has not made any submissions specifically in relation to the requested pain medication.
4. I note that the surveillance footage appears to show the applicant performing various manual work. I note that Dr Bentivoglio expressed an opinion regarding the applicant's pain, symptoms and capacity as demonstrated by the surveillance footage. However, the applicant addressed the surveillance footage in his last statement and explained the circumstances of the events depicted. Having regard to the evidence as a whole, I consider that the applicant's evidence and explanation in that regard to be an honest and legitimate account. Further, I note that in the surveillance footage, the applicant was wearing a knee brace and that he performed the work over separate days. In the circumstances, I do not find the surveillance footage to be particularly compelling evidence and I accept the applicant's explanation of those events and his evidence of ongoing symptoms and chronic pain as a result of the accepted injuries.
5. On that basis, I accept that the applicant suffered from ongoing symptoms and chronic pain as a result of the accepted injuries and that the pain medication is reasonably necessary to treat that pain.

Ongoing consultations with Dr Brian Hsu and CT guided epidural and steroid injection L5-S1

1. In relation to the requested ongoing consultations and CT guided epidural and steroid injection L5-S1 requested by nominated treating specialist Dr Brian Hsu, orthopaedic surgeon (ARD 316), I note that Dr Hsu has been the applicant's treating surgeon since at least November 2023 and I am satisfied that he would have a good understanding of the applicant's clinical condition.
2. As I noted above, I accept that the applicant suffers from ongoing symptoms and chronic pain as a result of the accepted injuries. I accept that this includes lumbar spine symptoms.
3. I note that previous CT-guided cortisone injection was unsuccessful to treat the applicant's symptoms.
4. Dr Bentivoglio accepted that the applicant did sustain discal damage at the L4/5 level of the applicant's spine was caused by the accepted injuries and that the applicant would have ongoing intermittent symptoms in his back. I note that in his recent report dated

21 November 2025, Dr Bentivoglio, independent medical expert qualified by the insurer, opined that such an injection was "appropriate" but had made the applicant's symptoms worse. 5. However, that does not necessarily preclude the potential effectiveness and the reasonably necessity of a further CT guided epidural and steroid injection at L5-S1, particularly some years after the previous trial. 6. I note that the applicant has lost weight since the previous attempt at CT-guided cortisone injection. 7. In relation to alternative treatments, A/Prof Steel did not recommend any surgical intervention in the management of the applicant's lumbar spine. 8. There is no compelling evidence of any other alternative treatment. 9. The respondent has not made any submissions in relation to the cost of these treatments. 10. It is somewhat difficult to reconcile the evidence in relation to this particular treatment, however on balance, particularly in the absence of any compelling evidence of any alternative treatment to treat the applicant's ongoing back symptoms, I am satisfied that the treatment is reasonably necessary to treat the applicant's accepted back injury.

1. In relation to the MRI lumbar spine requested by Dr Morgan Mo on 15 January 2025 (ARD 310) and 26 August 2025 (ARD 317), as I noted above, I accept that the applicant suffers from ongoing symptoms and chronic pain as a result of the accepted injuries. I accept that this includes lumbar spine symptoms.
2. I note that the request for MRI lumbar spine made on 26 August 2025, was made following the applicant's presentation to Tamworth Hospital on 25 August 2025 in relation to a flare-up of his back pain. The Tamworth Hospital prescribed the applicant oxycodone medication and recommended an updated MRI to view the accepted back injury.
3. The respondent has not made any submissions specifically in relation to the requested MRI lumbar spine.
4. Having regard to the evidence as a whole, I consider that it is logical and likely that a further MRI lumbar spine is an appropriate and reasonably necessary radiological investigation to further investigate the accepted back injury in the context of recent flare-up of pain which required the applicant to present to hospital.
5. Accordingly I am satisfied that the MRI lumbar spine is reasonably necessary to treat the applicant's accepted back injury.

1. In relation to the right genicular nerve blocks to address right knee pain requested by the applicant's treating pain specialist, Dr Sushama Deshpande (ARD.311), in his report dated

8 May 2025, Dr Deshpande identifies that osteoarthritis of the applicant's right knee is secondary to the primary right knee injury due to both the trauma of the injury and the surgical intervention of the right knee arthroscopy. 2. As I noted above, I accept that the applicant suffers from ongoing symptoms and chronic pain as a result of the accepted injuries. I accept that this includes right knee symptoms. I note that the surveillance video depicted the applicant wearing a knee guard. 3. Dr Bentivoglio's opinion appears to be based on his view that the accepted right knee injury would have resolved by no later than 1 May 2022. The applicant submits that no weight should be given to the report of Dr Bentivoglio dated 14 November 2025 on the basis that he was not afforded procedural fairness and because Dr Bentivoglio has not assessed the applicant for almost a year, since December 2024, and in the interim period the applicant has lost a substantial amount of weight with the use of Trizepatide medication. Further, the applicant submitted that the respondent had not arranged for the applicant to be medically assessed in relation to these claims. 4. Considering the evidence as a whole, I prefer and accept the opinion of Dr Deshpande. I consider that, as the applicant's treating pain specialist, Dr Deshpande has a good understanding of the applicant's accepted knee injury and the clinical picture and maintains that right genicular nerve blocks is reasonably necessary to treat the injury. Further, I am satisfied that Dr Desphande's report provides a sound basis for her opinion that treatment with right genicular nerve blocks is appropriate to treat the accepted right knee injury. 5. There is no compelling evidence of an appropriate alternative treatment. 6. The respondent has not made any submissions in relation to cost of the treatment. 7. Having regard to the evidence as a whole, I consider that it is logical and likely that right genicular nerve blocks is an appropriate and reasonably necessary treatment for the applicant's accepted right knee injury. 8. Accordingly I am satisfied that the right genicular nerve blocks is reasonably necessary to treat the applicant's accepted right knee injury.

Is the treatment reasonably necessary as a result of the injury?

1. Considering the statutory provisions, the case law and the evidence as a whole, applying a commonsense evaluation to the evidence, and for all of the reasons that I have set out above, I am satisfied on the balance of probabilities and find that the necessary causal connection exists and that the respective treatments are reasonably necessary as a result of the accepted injuries.

1. For all the reasons set out above, I find as follows:

(a) the various claimed treatments are all reasonably necessary treatment as a result of the accepted injuries, pursuant to s 60 of the 1987 Act.

(a) in accordance with s 60 of the 1987 Act_,_ the respondent to pay the past costs of and incidental to the claimed treatments.

[1] Leave was granted to the applicant to amend the ARD in accordance with a direction issued on

[2] [1986] NSWCC2; [1986] NSWCC 2; (1986) 2 NSWCCR 32.

[3] [2014] NSWWCCPD 72.

[4] [1986] NSWCC2; [1986] NSWCC 2; (1986) 2 NSWCCR 32.

[5] [1997] NSWCC 1; 14 NSWCCR 233.

[6] (1994) 35 NSWLR 452; 10 NSWCCR 796.

[7] Kooragang, at [461] (Sheller and Powell JJA agreeing).

[8] [2016] HCA 43, at [42].

[9] [2015] NSWWCCPD 49.

[10] [2009] NSWWCCPD 134.

[11] See also Kumar v Royal Comfort Bedding Pty Ltd [2012] NSWWCCPD 8, at [61].

[12] [2013] NSWWCCPD 4.

[13] [2011] NSWWCCPD 51.