austlii:nsw/NSWPIC/2025/313
General information, not legal advice.
NSWPIC
2025-07-02
Original judgment source is linked above.
The merit and substance of the issue that is sought to be raised
(a) sales assistant - department warehouse;
(b) deliver driver (van or car - light items), and
(c) parking inspector.
Dr Wijenayake the applicant is not totally unfit for work recommending work days of a maximum of six hours with an hour break in the middle and a maximum of four days per week, totalling 24-28 hours per week with restrictions.
The degree of difficulty or complexity to which the unnotified issues give rise
When the insurer notified that it wished to contest any unnotified issue(s); did the respondent act promptly to bring the matter to the attention of the Commission and all other parties; any unreasonable or unexplained delay in giving notice; in what circumstances the worker was first made aware of the unnotified issue; general conduct of the parties in the proceedings
30 October 2024 from Dr Wijenayake having been examined by the doctor on
21 October 2024 as well as a report from the applicant's general practitioner (GP) Dr Masud-Ul-Haq dated 19 August 2024.[25] It is clear from the reports of Dr Wijenayake and Dr Masud-Ul-Haq that both doctors were asked to comment on and provide their opinions in respect to the applicant's work capacity, which both doctors did. 7. After the issuing of the review notice on 9 December 2024 payments of weekly compensation were not made in accordance with the review notice. The applicant filed an ARD with the Commission on 24 January 2025 commencing these proceedings. Among the documents attached to that application was the said statement by the applicant, the reports of Dr Wijenayake and Dr Masud-Ul-Haq as well as the work capacity decision and the s 78 notice dated 15 July 2024. The review notice was not among the documents lodged with the ARD. 8. The respondent lodge a Reply on 13 February 2025. The Reply filed on behalf of the respondent confirmed the matters in dispute as per the dispute notices attached to the application. Attached to the Reply was the work capacity decision as well as the review notice. Also attached to the Reply was the vocational assessment report of Pinnacle Rehab dated 7 June 2024, a Doctors Sign Off completed by Dr Rahman as well as the Certificate of Capacity completed by Dr Rahman dated 30 May 2024. These documents had formed the attachments to the work capacity decision. 9. The respondent lodged an ALAD with the Commission dated 20 March 2025 which had attached to it the reports of Dr Miniter dated 17 June 2024 and 27 June 2024 as well as a list of workers compensation payments. The reports of Dr Miniter had formed the attachments to the s 78 notice of 15 July 2024. 10. At the preliminary conference before me on 11 March 2025 the parties agreed the PIAWE amount and advised that the only issue in dispute between the parties was incapacity. At the time of the preliminary conference no objection was raised as to notice of the dispute and no issue raised as to the status of the dispute notices. A Direction was issued by the Commission dated 11 March 2025 which recorded as a notation that "[T]he only issue in dispute is s 33 - incapacity." At that time the respondent had not as yet lodged its ALAD dated 20 March 2025 and therefore the only evidence served by the respondent went to the issue of incapacity. 11. Whilst the respondent did not issue a further s 78 notice after the initial conciliation conference/arbitration hearing on 19 March 2025 the parties were clearly aware that incapacity was in issue and the evidence relied upon by the respondent.
The degree to which the insurer has otherwise fulfilled its statutory obligation to notify the worker of its decision disputing liability
Any prejudice that may be occasioned to the worker
"(1) An insurer must not discontinue payment to a worker of weekly payments of compensation, or reduce the amount of the compensation, unless the required period of notice (commencing when the notice of discontinuation or reduction is given in accordance with this Division) has expired."
Any other relevant matters arising from the particular circumstances of the case
Commission must act according to equity, good conscience and the substantial merits of the case
(a) denying liability;
(b) disputing payment of weekly compensation from 7 August 2024 to date, and
(c) relying on the vocational assessment report by Pinnacle Rehab dated
7 June 2024 and the assertion that a Parking Inspector is suitable employment.
"prevents a party from unjustly resiling from an assumed state of affairs which he or she has induced another party to adopt as the basis of some act or omission which, if the assumption were not adhered to, would operate to that other party's detriment. The object of that estoppel is to prevent the detriment which the other party would suffer if the assumption were deserted."
"Since an estoppel will not arise unless the party claiming the benefit of it has adopted the assumption as a basis of action or inaction and thereby placed himself in a position of significant disadvantage if departure from the assumption be permitted; the resolution of an issue of estoppel by conduct will involve an examination of the relevant belief, actions and position of that party."
"The central principle of the doctrine of estoppel by conduct is that the law will not permit an unconscionable departure by one party from the subject matter of an assumption which has been adopted by the other party as the basis of some course of conduct which would operate to that other party's detriment if the assumption were not adhered to for the purpose of the litigation (Deane J in Verwayen at 444)."
"1. Did the representor cause the representee to adopt the assumption on which the estoppel is based?
(a) the applicant has been without weekly compensation from 7 August 2024;
(b) the applicant has been forced to instruct lawyers;
(c) the applicant has been forced to commence proceedings in the Commission to enforce the representations made by the respondent, and
(d) section 80(3) of the 1998 Act provides for a "required period of notice" of three months for a decision made on the basis of any reassessment by the insurer of the entitlement to weekly payments of compensation resulting from a work capacity decision of the insurer to be given prior to a reduction or discontinuance of weekly payments of compensation. In the applicant's submission as the ARD was filed with the Commission on 24 January 2025, within the 12 week notice period of the review notice dated 9 December 2024 the applicant suffers the detriment of inability to obtain a stay on the work capacity decision pursuant to s 289B the 1998 Act.
9 December 2024 was not annexed to the ARD. 5. At the preliminary conference before me on 11 March 2025 the parties agreed the amount of the applicant's PIAWE and advised that the only issue in dispute between the parties was incapacity. At the time of the preliminary conference no objection was raised as to notice of the dispute in respect to incapacity and no issue raised as to the status of the dispute notices. A Direction was issued by the Commission dated 11 March 2025 which recorded as a notation that "[T]he only issue in dispute is s 33 - incapacity." At that time the respondent had not as yet lodged its ALAD dated 20 March 2025 and therefore the only evidence served by the respondent went to the issue of incapacity. 6. It would appear that the only detriment that possibly occurred as a result of any reliance on the review notice was possibly some short delay in the lodging of the ARD which was still lodged fairly expeditiously. 7. In the respondent's submission there is no detriment. That as I have determined that there is no valid dispute notice and that the applicant is entitled to weekly payments of compensation from 7 August 2024 onwards and that despite the fact that he commenced proceedings in the Commission the applicant does not have any legal costs to pay. 8. I accept that the applicant has suffered a detriment as a result of not being paid the weekly compensation in accordance with the statement made in the review notice dated
9 December 2024. However, this detriment does not arise as a result of the applicant's reliance on an assumption but simply because the promised compensation was not paid. Furthermore I have previously determined that that there is no valid extant dispute notice given the effect of the review notice and that the applicant has an entitlement to weekly compensation pursuant to s 37(1) of the 1987 Act on the basis of total incapacity from
7 August 2024 to at least 30 April 2025 (the date on which leave was granted pursuant to s 289A(4) to raise a dispute in respect to incapacity). The respondent has therefore not been permitted to resile from its statement that it would make payments of weekly compensation to the applicant at least until the granting of leave under s 289A on 30 April 2025. 9. As previously discussed the fact that liability may be accepted for the payment of weekly compensation at a particular rate does not mean that those payments are to be made in perpetuity. Disputes in respect to liability to pay weekly compensation or as to the amount to be paid can arise for a number of reasons after liability has been previously accepted and weekly compensation paid. The legislation provides for such disputes. 10. Relevantly s 44A of the 1987 Act requires an insurer to conduct assessments of an injured worker's current work capacity, work capacity assessment. Section 78 of the 1998 provides that notice of any decision to dispute liability in respect of a claim or any aspect of a claim or decision to discontinue or reduce the amount of weekly payments of compensation be given. Section 78 of the 1998 Act provides the requirements for the giving of that notice whilst s 80 of the 1998 Act provides the required notice periods. 11. In the current matter the procedure which is required by the legislation to be followed when discontinuing or reducing weekly compensation has gone amiss. 12. Given the applicable legislation, the nature of the statutory scheme as well as potential changes in the applicant's physical capacity for paid employment it was always open to the respondent to review its decision to pay weekly compensation and raise a dispute as to incapacity and this is what the respondent has been granted leave to do under s 289A(4). The granting of leave to raise a new matter has its own requirements and factors that need to be consider in respect to the discretion under s 289A(4). It is therefore in my view not unjust or unreasonable for the respondent to raise the new dispute. It was never open to the applicant to assume that the payments of weekly benefits compensation would continue indefinitely as a result of the review notice. 13. I do not accept the applicant's submission that he suffered a detriment as a result of the inability to obtain a stay on the work capacity decision pursuant to s 289B of the 1998 Act. The applicant submits that this detriment arises as a result of the filing of the ARD within three months of the s 287A review notice. Section 289B provides that
"289B Stay of disputed work capacity decision
(1) The referral of a dispute for determination by the Commission in relation to a work capacity decision to discontinue, or reduce the amount of, weekly payments of compensation operates to stay the decision and prevents the taking of action by an insurer based on the decision while the decision is stayed.
(2) However, the decision is stayed only if the dispute is referred for determination by the Commission before the expiry of the required period of notice under section 80.
(3) A stay operates from the time the President accepts the dispute for referral until the proceedings are determined, dismissed or discontinued.
(4) The Commission may, if it considers that a party to the dispute is unreasonably delaying the proceedings on the dispute, order that the stay ceases to have effect."
"33 Weekly compensation during total or partial incapacity for work
If total or partial incapacity for work results from an injury, the compensation payable by the employer under this Act to the injured worker shall include a weekly payment during the incapacity.
Chapter 3 of the 1998 Act (Workplace injury management) provides that, if a worker fails unreasonably to comply with a requirement of that Chapter after being requested to do so by an insurer, the worker has no entitlement to weekly payments of compensation for the period that the failure continues."
"9 Meaning of 'current work capacity' and 'no current work capacity'
(1) An injured worker has 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.
(2) An injured worker has 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 pre-injury employment or in suitable employment."
"suitable employment, in relation to a worker, means employment in work for which the worker is currently suited -
(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
(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."
(a) sales assistant - department warehouse;
(b) deliver driver (van or car - light items), and
(c) parking inspector.
(a) while sitting for around 40 minutes, he has a pain level of 4/10 in his right shoulder because posing his arms whilst sitting puts pressure on his injury;
(b) while driving for around one hour, he has a pain level of 4/10 in his right shoulder during turning the car because of moving a gear stick with his arms whilst driving puts pressure on his injury,
(c) while lifting around 5kg above shoulder height for around five minutes, he has a pain level of 6/10 in his right shoulder because of lifting his arms whilst lifting items puts pressure on his injury;
(d) while pushing and pulling around 10kg for around five minutes, he has a pain level of 6/10 in his right shoulder because of pulling and pushing with his arms puts pressure on his arms, and
(e) while lifting around 5kg below shoulder height for around five minutes, he has a pain level of 6/10 in his right shoulder because lifting with his arms puts pressure on his arms.
Mr Gauci noted that they had to reduce exercise volume due to increased pain with these flare ups. The results of a lifting assessment were floor to waist 25kg, waist to shoulder 10kg, overhead 5kg, single arm carry 10kg and push/pull 25kg. The applicant was aware of some level of discomfort with all lifts however they were manageable. 9. Mr Gauci assessed that the applicant was able to complete "PTSD" days/hours. I assume that "PTSD" stands for part time suitable duties however Mr Gauci did not provide the hours per day or the number of days per week which the applicant could work nor state whether the days could be consecutive or needed to be alternate. The restrictions which were applied were lifting/carrying capacity floor to waist of 25kg, waist to shoulder of 10kg and overhead of 5kg and pushing/pulling ability of 25kg. Mr Gauci provided the following additional comment "lifting should be kept non-repetitive, prolonged tasks will likely need to be broken up with rests as tolerated."[34] 10. On 12 July 2024 Mr Gauci reported to EML that the applicant was continuing to experience shoulder pain noting that it had been difficult managing flare ups and aggravations since the last assessment. However, Mr Gauci noted that the applicant had been overexerting himself at times. Mr Gauci discussed with the applicant the importance of managing his physical output when at home to keep the inflammation down. 11. The results of a lifting assessment were floor to waist 25kg, waist to shoulder 10kg, overhead 5kg, single arm carry 10kg and push/pull 25kg. The applicant was aware of some level of discomfort with all lifts. 12. Mr Gauci again assessed that the applicant was able to complete "PTSD" days/hours. However again Mr Gauci did not provide the hours per day or the number of days per week which the applicant could work nor whether the days could be consecutive or needed to be alternate. The restrictions which were applied were lifting/carrying capacity floor to waist of 25kg, waist to shoulder of 10kg and overhead of 5kg and pushing/pulling ability of 25kg.
Mr Gauci again provided the following additional comment "lifting should be kept non-repetitive, prolonged tasks will likely need to be broken up with rests as tolerated." 13. Mr Gauci believed that the applicant was able to complete some level of employment in his current condition. Mr Gauci was of the opinion that the applicant would be best suited to something that involves breaks between repetitive movement and limited or no overhead lifting. He was also of the opinion that having a break between workdays would be beneficial.[35] 14. Dr Wijenayake, orthopaedic surgeon, who examined the applicant on 21 October 2024 providing a forensic report to the applicant dated 30 October 2024[36] noted that the applicant had shoulder surgery performed on 16 November 2023 in the form of a right acromioplasty and rotator cuff repair with the operation notes indicating findings of a large full-thickness supraspinatus tear, severe bursitis, and subacromial impingement. [37] 15. Dr Wijenayake records that the applicant reported baseline pain in the anterior aspect of his shoulder. This pain he rated as a 3 to 4 out of 10 on a visual analogue scale (VAS). The pain was aggravated by moving, lifting, or driving for extended periods of time. When aggravated, this pain becomes sharp and reaches a 6 out of 10 (VAS). The pain is improved by rest.
Mr Lean also experienced a reduced range of motion as well as some reduced function due to the symptoms in his shoulder.[38] 16. In the opinion of Dr Wijenayake the applicant is not totally unfit for work. If the applicant were to return to his previous employment, Dr Wijenayake recommend this return under the following restrictions. No heavy lifting of more than 10kg. No lifting above shoulder level and no repetitive lifting. The doctor recommends work days having a maximum of six hours a day with an hour break in the middle and a maximum of four days per week, totalling 24-28 hours per week. These recommendations are to ensure no aggravation of symptoms.[39] 17. In an open labour market, Mr Lean should have a restriction of no overhead lifting, no repetitive lifting, and lifting restrictions of 10kg. He will also require regular breaks for any manual work.[40] 18. A/Prof Miniter, orthopaedic surgeon, provided a forensic report to the respondent dated
17 June 2024 regarded the applicant as fit to return to his normal duties. 19. I do not accept the opinion of A/Prof Miniter as to the applicant's capacity. The doctor does not take history or explore in any way the nature of the applicant's pre-injury work duties and does not take a history in respect to the applicant's failed attempt to return to work. The opinion is also inconsistent with the applicant's attempt to return to his pre-injury duties where he suffered an aggravation of his condition within the first day. 20. I prefer the assessments of the applicant's functional capacity provided by the exercise physiologist, Mr Gauci. Whilst Mr Gauci is not a doctor he has assessed the applicant on multiple occasions, performed tests of his physical capacity and has been working with the applicant to improve his strength and functional capacity. Importantly Mr Gauci has also been advised as to when the applicant has suffered flare ups of his shoulder symptoms as a result of exceeding his physical capabilities. It would also seem that Dr Rahman adopted in his Certificate of Capacity dated 30 May 2024 (which was relied upon for Pinnacle Rehab for the vocational assessment) the capacities assessed by Mr Gauci. 21. The applicant's physical capacity as assessed by Mr Gauci is not necessarily inconsistent with the opinion of Dr Wijenayake as to the applicant's work capacity. Whilst Dr Wijenayake recommended no heavy lifting of more than 10kg. No lifting above shoulder level and no repetitive lifting and recommend maximum workdays of six hours a day with an hour break in the middle and a maximum of four days per week, totalling 24-28 hours per week. These recommendations were to ensure no aggravation of symptoms. Mr Gauci records that the applicant was suffering flareups of pain with activities and the restrictions which Mr Gauci placed on the applicant's lifting/carrying and pulling /pushing ability match the testing which Mr Gauci performed. In the most recent available reports from Mr Gauci dated 30 June 2024 and 12 July 2024 he commented that "lifting should be kept non-repetitive, prolonged tasks will likely need to be broken up with rests as tolerated." 22. I am therefore of the view that the applicant does have an incapacity for work. 23. The respondent bears the onus of proving the residual earning capacity. 24. I now turn to a consideration of suitable employment. 25. The respondent submits that I should accept the vocational options identified by Pinnacle Rehab as being occupations which are suitable for the applicant given the restrictions which arise as a result of the injury. 26. I accept that the occupations identified by Pinnacle Rehab are real and potentially available on the open labour market.[41] There was no submission made to the effect that they are not. 27. I now turn to a consideration of the three occupations identified by Pinnacle Rehab. However before doing so I note that whilst Dr Wijenayake does appear to indicate that the applicant could return to his pre-injury duties as a Truck Driver with restrictions the work capacity assessment of Pinnacle Rehab specifically rejected truck driving as a suitable employment option. Pinnacle Rehab excluded Truck Driver as a suitable employment option on the basis that the "[f]unctional requirement of the role would necessitate an upgrade to Mr Lean's capacity to ensure his suitability." I also note that the applicant attempted a trial of truck driving duties in early July 2024 suffering right shoulder pain after 4 hours.[42]
Dr Rahman to approve or reject significantly does not contain any detail or reference to the actual weights which the applicant would be required to lift/carry/push/pull.
30 June 2024 and 12 July 2024 what the part time hours are which the applicant can work. However there only appears to be a marginal change on testing between the applicant's capacity as reported on 10 May 2024 to that of 30 June 2024 and 12 July 2024 which may indicate that the hours previously assessed remain unchanged. 11. Doing the best I can with the evidence before me I am of the view and find that the applicant has the capacity and has had the capacity to work as a Parking Inspector since 30 April 2025 24 hours per week (eight hours per day, three days per week). The vocational assessment report of Pinnacle Rehab reported, based on labour market analysis, remuneration of $816 per week for a 24 hour work week as a Parking Inspector. The evidence of Pinnacle Rehab as to the earnings of a Parking Inspector are unchallenged and I accept that evidence. 12. For the above reasons I find that the applicant has had from 30 April 2025 and continues to have the capacity to earn $816 per week working 24 hours per week as a Parking Inspector. 13. The respondent submits that the applicant is entitled to receive a period of notice pursuant to s 80 of the 1998 Act from 30 April 2025 when leave was granted pursuant to s 289A to dispute incapacity. No submissions were made by the respondent on this issue. I accept this submission and have previously given reasons for this view. I am not of the view that the granting of leave to dispute incapacity is a work capacity decision as defined by s 43 of the 1998 Act. No decision has been given by the insurer and the necessary information has not been provided. In my view and I find given the weekly compensation payments which the applicant should have received and will receive to 30 April 2025 s 80(4)(b) applies and the applicant is entitled to six weeks notice from 1 May 2025 to 11 June 2025.
[1] Application to Resolve a Dispute (ARD) p. 1.
[26] Clause 41(3) Workers Compensation Regulation 2016.
[41] See Wollongong Nursing Home Pty Ltd v Dewar [2014] NSWWCCPD 55 (Dewar).
Lean
Raygal Pty Ltd [2025] NSWPIC 313;
(1990) 170 CLR 394