(a) $1,608 per week from 14 February 2024 to 31 March 2024,

(b) $1,640 per week from 1 April 2024 to 30 September 2024,

(c) $1,672 per week from 1 October 2024 to 31 March 2025,

(d) $1,680 per week from 1 April 2025 to 30 September 2025 and thereafter as indexed.

1. The respondent is to pay the applicant's reasonably necessary medical expenses pursuant to s 60.
2. The lump sum claim is remitted to the President for referral to a Medical Assessor to assess permanent impairment as follows:

Materials: Application to Resolve a Dispute and attachments, Reply and attachments.

A brief statement is attached setting out the Commission's reasons for the determination.

1. The applicant alleges that, on 16 December 2020 whilst at work, an air-conditioning duct panel fell from a hoist and struck his right temple. He was wearing a helmet at the time.
2. He was knocked unconscious by the high impact and weight of the air conditioning duct panel. He states that the panel fell from a height of 1 to 3m and weighed approximately

20kg. 3. As a result of this accident, the applicant alleges that he suffered a head concussion, bleeding and head injuries to the right temple requiring stitches. He also suffered injury to his neck, symptoms in the left eye which being blurred vision and a loss of depth perception, debilitating headaches and dizziness, cognitive difficulties including but not limited to memory loss and terror mares or sleep terrors.

1. The applicant claims weekly payments of compensation from 14 February 2024, a whole person impairment of 45% arising from injury to the nervous system (based on the assessment of Dr Paul Teychenne of 7 June 2024) and payment of medical expenses.
2. The respondent relies on the opinion of an independent neurologist, Dr John Hugh O'Neill. It has refused compensation payments from 14 February 2024. Whilst the respondent originally accepted liability it now rejects any causative link between the accident at work on 16 December 2020, and any alleged continuing incapacity for work experienced by the applicant, any outstanding or continuing medical treatment expenses or any whole person impairment.

PROCEDURE BEFORE THE PERSONAL INJURY COMMISSION

1. Mr Ross Hanrahan of counsel, instructed by Ms Gill of Shine Lawyers, appeared for the applicant.
2. Mr Gaitanis of counsel, instructed by Ms Lewis of Rankin Ellison Lawyers, appeared for the respondent.
3. I am satisfied that the parties to the dispute understood the nature of the application and the legal implications of any assertion made in the information supplied. I used my best endeavours in attempting to bring the parties to the dispute to a settlement acceptable to all of them. I am satisfied that the parties have had sufficient opportunity to explore settlement and that they have been unable to reach an agreed resolution of the dispute.

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

(a) Application to Resolve a Dispute (ARD) and attached documents, and

(b) Reply to ARD (Reply) and attached documents.

1. The applicant had a motor vehicle accident in 2004 or 2005. As a pedestrian he was hit by a reversing vehicle. He attended Ryde Hospital and was admitted for two days. He states that he was cleared of any serious injury and was not prescribed any medical treatment.
2. The applicant states that, following the accident on 16 December 2020, after he had recovered consciousness, he was taken to the Rocks Medical Centre by colleagues. He had four stitches there. He experienced double vision in his left eye and a severe headache. He was provided with a medical certificate for two days absence from work.
3. Following the accident the applicant suffered neck pain, headaches and dizziness. He relied upon painkillers.
4. On 2 July 2021 he attended his general practitioner (GP) Dr Ktenas regarding worsening neck pain and headaches. He was also suffering vertigo and blurred vision. He was referred for an MRI in relation to his head and neck injuries. He was certified as unfit for work, and he ceased work.
5. On 16 July 2021 the applicant had an MRI scan.
6. On 19 July 2021 Dr Ktenas advised the applicant that he had a lesion. He referred him to neurosurgeon Dr Peter Wilson for treatment and management. Dr Wilson confirmed that he had a lesion and that his symptoms were caused by the accident at work. He was advised to repeat the scan in three months to see if the lesion had progressed or changed. Dr Wilson recommended a referral to an ophthalmologist for his left-sided double or blurred vision and dizziness.
7. During August 2021 the applicant continued to consult with Dr Ktenas. His vertigo and vision problems were worsening. Dr Ktenas advised him to report his memory problems to

Dr Wilson. 8. On 13 October 2021 the applicant underwent a further MRI. Dr Ktenas advised that the lesion had not changed. 9. On 26 October he was referred to Dr Ron Granot, neurologist. 10. On 3 November 2021 Dr Wilson reviewed the latest MRI scan and confirmed to the applicant that the condition of the lesion was the same and advised the applicant to monitor his symptoms in case there were changes. 11. On 15 February 2022 the applicant consulted Dr Granot. His symptoms were double vision on the left side, dizziness, headaches, neck pain and stiffness, and poor memory. He was prescribed medication for management of his dizziness, neck pain, headaches and nausea. 12. In May 2022 the applicant was involved in a motor vehicle accident. His vehicle was rear-ended, and he crashed into a car in front of him. He suffered whiplash and neck injuries. The applicant made a claim on the NRMA. The claim was eventually closed and the injuries resolved. 13. On 27 July 2022 the applicant was referred to Professor Stephanie Watson regarding his vision difficulties and headaches. 14. On 29 July 2022 the applicant consulted a Professor Watson. The applicant states that she confirmed that his workplace accident had caused his double vision and memory issues. She considered the whiplash injuries sustained as a result of his car accident had aggravated his headaches. 15. On 19 September 2022 the applicant consulted Dr Granot regarding worsening headaches and neck pain. Dr Granot referred him to a brain injury rehabilitation specialist, Dr Stuart Browne, for his opinion and management. 16. The applicant states that Dr Browne advised that the car accident had aggravated his headaches and neck pain and at the workplace injury had caused post-traumatic migraines. The applicant was then still suffering sharp headaches and neck pain. 17. The applicant continued to follow the prescribed medication. 18. On 18 September 2023 (this date may be an error since the MRI referred to Dr Granot occurred on 21 March 2023) the applicant states that he had a further brain MRI. There were no changes to the lesion. 19. On 21 March 2023 the applicant consulted Dr Granot. The MRI was reviewed. He was advised he could work on reduced hours as tolerated, although double vision would be a limiting factor for job opportunities. He was still suffering migraines and pain in his neck, but his headaches were improving. 20. The applicant commenced contract work providing lighting and entertainment equipment. His work capacity fluctuated depending on his symptoms. He could not drive due to his double vision and he had memory problems. 21. On 15 May 2023 he again consulted Dr Watson. He was advised that he was not a candidate for surgery for his double vision. He would have to adjust his neck and head position to reduce the effect. 22. On 7 August 2023 he consulted his GP regarding his migraines and night terrors. He was advised to see a psychiatrist and provided with a referral. 23. On 12 September 2023 the applicant consulted Dr Browne again. He reported that he had been disorientated when catching public transport to see her, he was sleeping poorly and had constant migraines. He was often unable to work due to fatigue, poor concentration and double vision. 24. On 18 September 2003 he had a further MRI to monitor the lesion. There were no changes. 25. On 30 October 2023 Dr Wilson reviewed the latest MRI and advised that the left-sided lesion was slightly larger than the 2021 result. 26. The applicant has not been able to afford to consult a psychiatrist or continue specialist treatment since the denial of his claim. He consults his GP to monitor his health and symptoms. 27. In his statement he summarises the injuries arising from his accident as a concussion; head lacerations requiring stitches; a traumatic brain injury; a neck injury; visual impairment, namely diplopia or blurred vision and a loss of depth perception; right perinatal lesion; post-traumatic migraines and/or headaches and dizziness; cognitive difficulties including but not limited to memory loss; sleep terrors; speech difficulties, including stuttering, and psychological sequelae. 28. In relation to his work history the applicant states that he stopped working with the respondent within a few months of his accident due to his worsening symptoms. 29. As to his present fitness for work the applicant states:

"After some time, I started working in a limited capacity for an average of 2 to 3 hours per week providing entertainment and lighting equipment on rent for concerts and band shows. My working hours would depend on my pain and concentration levels, and it would involve designing and programming lights and some computer work. Any profits made from these temporary jobs were used to pay my subcontractors as I was working as a sole trader. I did not make any money from this venture after the expenses were accounted for due to the limiting nature of my injuries and inability to continue working. I am unemployed and cannot find suitable work that accommodates for the ongoing nature of my injuries."

1. Dr Paul Teychenne, consultant neurologist, qualified by the applicant's solicitors to provide an opinion, accepted the history provided by the applicant. He concluded that the injury suffered by the applicant was not minor. He reviewed the treating doctor's reports and provided the following diagnosis:

"I consider that Mr Loau had had a traumatic brain injury with cognitive deficits, particularly memory deficit and executive deficit. I consider Mr Loau had also had a high incomplete cervical cord injury and possible cervicomedullary injury.

I consider that he had sustained a traumatic brain injury with cognitive deficits." [1]

1. Dr Peter Wilson reported as follows on 28 July 2021:

"He reports suffering a hit to the right side of the head with a 90 kg air conditioning panel on 16 December 2020. He recalls being in the room prior to the trauma and then next waking up on the ground and being briefly disoriented when being questioned by his supervisor. He is not sure how he landed. There was profuse bleeding from the scalp on the right side which did require some sutures for haemostasis. Since the trauma, he has noted blurry vision and intermittent headaches. His vision is now normal looking full into the right but double looking to the left. There is intermittent vertigo on waking in the morning and looking upwards. He denies ever having any seizures. He has a background of emphysema for which he takes Spiriva and Ventolin, and multiple orthopaedic pathologies. He smokes two to three cigarettes a day and lives alone.

MRI brain performed on 16 July 221 shows a T2 heterogeneous hyperintensity in the left supramarginal gyrus including the cortex. These changes are not clearly evident on the T1 sequence and there is no enhancement.

The most likely cause of the radiological changes is a contrecoup injury. Nonetheless, it is not particularly typical for this and it may represent an alternative lesion such as cortical dysplasia or a low-grade glioma. I have suggested to repeat the scan in three months' time to ensure there is no radiological progression. In regard to his vision, it would be worth being reviewed by an ophthalmologist to confirm he has indeed sixth nerve palsy which is the most likely pathology after a closed head injury and also to provide some potential strategies for him to manage his diplopia."

1. On 10 August 2021 Dr Peter Wilson[2] provided a report opining that the applicant suffered a closed head injury, concussion and a persistent 6th nerve palsy as a result of being hit on the head the 90kg air-conditioning panel in the workplace. He concluded that the applicant has had persistent post concussive symptoms and diplopia directly related to the injury. Radiological findings from the MRI brain of 16 July 2021 were consistent with a post-traumatic lesion or a possible neoplasm.
2. Dr Ron Granot, consultant neurologist and neurophysiologist, provided the following summary in his report of 15 February 2022:[3]

The headaches have clear migrainous features, accompanied by appropriate migrainous exacerbating factors and are consistent with post-traumatic migraine headaches related to his head injury directly.

The frequency at this stage is borderline for prophylaxis and I will focus on acute therapy for now. I have asked for the episode frequency to be tracked in a diary I have provided.

In terms of acute therapy, I have advised that imigran and stemetil should be used PRN first and then I will consider Periactin as a preventative if frequency is higher or acute control ineffective.

His symptomatology is consistent with mild traumatic brain injury and I have asked him to see Dr Stuart Browne, for review, neuropsychometric assessment and involvement of an OT, for which purposes this may be used as a referral and for which I ask for insurer approval.

There is no clear brainstem lesion, but this is the longest intracranial nerve and may be damaged by trauma.

I have therefore asked for a neuro-ophthalmologist review with Dr Stephanie Watson to consider prisms as well, for which purposes this may be used as a referral and for which I ask for insurer approval.

This is concerning indeed for a low grade neoplasm. He requires a neurosurgical review, possibly a PET scan. I spoke to Dr Jacob Fairhall, who will kindly see him on an urgent basis, for which purposes this may be used as a referral and for which I ask for insurer approval."

1. Dr Ron Grabot provided a report dated 25 March 2024[4] in answer to a request by the applicant's solicitor. He reviewed Dr O'Neil's report of 27 November 2025.

He provided the following responses, as to diagnosis:

"Mixed post-traumatic migrainous headaches with neuropathic features. Head injury- unclear if meets markers of severity for an assessable Traumatic Brain Injury."

"There is a clear temporal relationship between the onset of the headaches and cognitive symptoms similarly. The question of meeting specific criteria of severity remains an open one and merits further review, but the uncertainty should not be interpreted as absence of possible causation."

... if the MRI changes are concluded to be compatible with a post-traumatic change, he does meet the criteria for an assessable traumatic brain injury .

he sustained a head injury and the severity of this is potentially in dispute given the lack of certainty around brain imaging changes. I would therefore not be able to conclusively state that he does or does not have an assessable Traumatic Brain injury until this is clarified, and if not, then he should continue to be treated as if this is the case."

1. The respondent denied liability for any continuing payments of compensation after

14 February 2024, liability for any ongoing medical treatment expenses and any claim for a whole person impairment. 2. The respondent relied on the medical reports of Dr John Hugh O'Neill dated

7 September 2021 and 27 November 2023, the medical reports of Dr Ron Granot dated

15 November 2020 and 21 March 2023 and the medical report of Dr Peter Wilson dated

14 November 2022. 3. Dr John Hugh O'Neill concluded that none of the symptoms about which the applicant now complains are causally related to the accident of 16 December 2020. 4. In its written submissions the respondent took the Commission to aspects of the applicant's past medical history, in particular complaints regarding vertigo and a sensation in the left eye prior to the accident of 16 December 2020. The applicant consulted a Dr Vyas on 22 November 2017.[5] On 17 August 2016 the applicant attended on a Dr Nguyen and complained of a "long-standing f.b. of RMB". The respondent characterises this as a probable reference to a long-standing foreign body of relapsed myelobrosis. Also, on

7 September 2016 the applicant had complained to Dr Nguyen of "recent freq vertigo attacks".[6] 5. The respondent submits that there is no evidence to support a finding that the applicant's employment was a substantial contributing factor to the applicant's alleged ongoing symptomatology or incapacity for work. It relies on the report of Dr John Hugh O'Neill who concluded that:

Today's review assessment would not cause me to change the essence of my conclusions as per my previous reports and particularly as per my report following clinical consultation on 27 November 2023. To be specific, Mr Loau sustained only a minor head injury in the work incident on 16 December 2020 and this minor head injury cannot be responsible for the subsequent development of symptoms which have progressively evolved even since I last saw him on 27 November 2023.

The abnormal signal detected in the left parietal region in the MRI scan on 16 July 2021 had not progressed and this too cannot be responsible for the progressive and varied nature of symptoms.

I now have absolutely no doubt that Mr Loau's current presentation is of a psychosomatic nature. He has new altered speech and balance without any explanation on physical examination. He has always had monocular (left eye) diplopia which is not due to a left sixth nerve palsy. Were that the case, the double vision would also be corrected on covering the right eye and that is not the case. His headaches are tension in type. He does report 'night terrors' of a psychological nature.

Mr Loau has never had symptoms or signs of a cervical cord lesion, and he has no radiological substrate for a cervical cord lesion. I totally refute Dr Teychenne's usual medicolegal diagnosis of an incomplete cervical cord lesion.

In short, the work injury on 16 December 2020 is not a substantial contributing factor to current symptoms except possibly on a psychological basis.

Current symptoms are ostensibly stable although symptoms have continued to worsen over time. There is no impairment of a physical nature arising from the mild closed head injury on 16 December 2020."

1. The respondent drew my attention to the applicant's previous medical history. Dr Vyas and Dr Nguyen had previously noted the sensation of a foreign body in the applicant's left eye.[7] There were also some previous instances of notifications of vertigo.[8]
2. The respondent submitted that it was not permissible for the Commission to accept the applicant's history of vertigo arising subsequent to the accident of December 2020 when there have been frequent attacks before the event.
3. Firstly, I am not persuaded that the previous attacks of vertigo can be characterised as frequent. Secondly, I am not persuaded that the history, even as characterised by the respondent, prevents my accepting the applicant's history of the onset of significant vertigo following the accident. The applicant's credibility has not been adversely affected by any matter in evidence before me. I accept the applicant's history regarding the onset of vertigo and diplopia.
4. The respondent accepted that the applicant sustained injuries on 16 December 2022 to his neck and right temple. It now relies on Dr John Hugh O'Neill to assert that none of the symptoms from which the applicant now suffers are causally related to the accident on

16 December 2020. 5. Dr O'Neill characterises the blow to the applicant's head as a mild closed head injury. I reject that characterisation. There is no persuasive reasoning provided by the doctor for a factual conclusion that the injury was mild. Neither does the fact that the applicant's injury was a closed head injury persuade me that it was therefore a mild injury. 6. On the contrary, I am satisfied and find that the applicant sustained a substantial blow to the head in the accident of 16 December 2020. 7. I accept the applicant's factual account concerning the accident. The applicant was certainly not hit by a 90kg piece of air-conditioning duct as recorded by Dr Peter Wilson. That reference is clearly an error. However, I am satisfied and find that the blow to the applicant's head was substantial. The applicant is not a heavy person, but I am satisfied that a blow to the head from an object weighing approximately 20kg would be a substantial and significant event for any person. It was sufficient to throw the applicant's body 2 to 3m, cause the need for sutures and produce a period of unconsciousness. 8. The applicant has not had the opportunity to pursue a psychiatric assessment, a neuropsychological assessment or an ophthalmic specialist examination because of lack of funds. 9. The Independent Review Office (IRO) has refused to pay for a neuropsychological assessment. Whilst such an assessment may be helpful and there was some discussion between the parties before the hearing commenced as to whether the IRO should have funded such an examination, I am satisfied that there is, in any event, sufficient medical evidence to support a finding of a traumatic head injury resulting in injury to the nervous system, a neck injury, headaches, vertigo, diplopia, cognitive difficulties and a continuing incapacity for work. 10. The applicant seeks an assessment of any consequent whole person impairment resulting from the injury to his nervous system by a Medical Assessor. 11. Counsel for the applicant referred to the decision of the High Court in Adelaide Stevedoring Company Ltd v Forst (Forst) where the Court upheld findings of fact made in the Court below. It held that, where there is a conflict of medical evidence, the decision maker is entitled to arrive at a conclusion "however difficult or invidious it might be made, by the state of scientific knowledge and opinion ... by a course of reasoning which combined common sense with the application of logic to physiological facts, to infer on the preponderance of probabilities" what a certain "sequence of events would naturally inspire in the mind of any common sense person uninstructed in pathology". [9] 12. Injuries arising from a traumatic blow to the head are complex matters, often giving rise to contrary diagnoses and prognoses. The applicant's case is no exception. However, I have no reason to reject the applicant's account of the circumstances of the accident and its physical consequences. I am impressed by the applicant's continued search for an answer to the adverse physical sequelae he has suffered in the past and continues to suffer. 13. I am not persuaded by the conclusion of Dr Teychenne regarding a high incomplete cervical cord injury or a cervicomedullary injury and, on balance, I consider that any neck symptoms presently suffered by the applicant are more likely than not to have arisen from the motor vehicle accident which occurred subsequent to the accident of 16 December 2020.

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

[9] HCA [1940] HCA 45; [1940] 64 CLR 538.