(a) $2,320 per week between 5 June 2025 and 30 September 2025;

(b) $2,352 per week between 1 October 2025 and 31 March 2026, and

(c) $2,400 per week from 1 April 2026.

1. Both parties are granted leave to approach the Commission in relation to any errors in the mathematical calculations made by the Commission in these orders - such leave is to be exercised on or before 16 April 2026.

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

1. Kathryn Mathews (the applicant) is 63-years-old. Apart for a period of approximately two years, she has worked since 1981 for Hunter New England Local Health District (the respondent) or its predecessors in name, in nursing roles. She remains employed by the respondent, and has worked at its Maitland Hospital since June 2003.
2. She alleges that she sustained an injury to her right hip on 6 January 2025, for which she claimed compensation from the respondent. The injury was initially accepted by the respondent as being compensable, and the applicant therefore received weekly benefits compensation as well as payment of her expenses pursuant to s 60 of the Workers Compensation Act 1987 (the 1987 Act), until 5 June 2025.
3. Prior to 6 January 2025, the applicant had had previous right hip symptoms, and indeed, she had undergone a right total hip replacement (under Dr McGrath) on 30 September 2024.
4. By way of a notice pursuant to s 78 of the Workplace Injury Management and Workers Compensation Act 1998 (the 1998 Act) dated 3 June 2025, the respondent denied liability to pay either weekly benefits compensation or expenses pursuant to s 60 of the 1987 Act, from 5 June 2025. The respondent later confirmed its liability decision in this regard by way of a further notice pursuant to s 78 of the 1998 Act dated 28 November 2025.
5. The applicant has not worked for the respondent since 11 January 2025 and therefore claims weekly benefits compensation from it since the weekly benefits compensation payments ceased on 5 June 2025.
6. The applicant has also incurred medical expenses in relation to her right hip treatment since 5 June 2025, specifically relating to a revision right total hip replacement that she underwent (also under Dr McGrath) on 15 October 2025. She therefore also claims expenses pursuant to s 60 of the 1987 Act since 5 June 2025.
7. The applicant's claims for weekly benefits compensation and expenses pursuant to s 60 of the 1987 Act were included in an Application to Resolve a Dispute (ARD) which was filed by her with the Personal Injury Commission (Commission) on 10 October 2025.

1. The parties have agreed that the following issues are in dispute and require determination in these proceedings:

(a) did the applicant sustain an injury to her right hip on 6 January 2025, in accordance with ss 4 and 9A of the 1987 Act;

(b) did the applicant sustain a consequential infection in her right hip, resulting from an injury sustained by her on 6 January 2025;

(c) is the applicant entitled to an award pursuant to s 60 of the 1987 Act, specifically in relation to the costs of and incidental to the revision right total hip replacement surgery performed upon her by Dr McGrath on 15 October 2025, and

(d) is the applicant entitled to weekly benefits compensation (as a result of an injury sustained by her on 6 January 2025 injury) from 5 June 2025 to date and continuing, pursuant to s 37 of the 1987 Act - if so, what weekly amount should be awarded to her in this regard.

PROCEDURE BEFORE THE PERSONAL INJURY COMMISSION

1. I am satisfied that the parties to these proceedings 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 proceedings 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 in the proceedings.
2. The proceedings were listed for conciliation/arbitration before me at Newcastle on

13 January 2026. On that occasion, Mr Boris Necovski of counsel appeared for the applicant, instructed by Ms Blair; and Mr Alexander Gallimore of counsel appeared for the respondent, instructed by Mr Gilmour and Ms Chandler. The applicant was present and supported by

Ms Aitken. The respondent's insurer was represented by Mr Sherry, and the respondent itself was represented by Mr Crosdale and Ms Reader. 3. After a lengthy unsuccessful conciliation process on 13 January 2026, time constraints did not allow an arbitration hearing to fully proceed. Only preliminary issues were therefore discussed, and I ordered a timetable for the provision of written submissions by both parties. 4. I advised that I would determine the issues to be determined in the proceedings 'on the papers' after the provision of the written submissions. I thank the parties for providing their written submissions in accordance with the timetable. 5. The preliminary issues which were discussed on 13 January 2026 were as follows:

(a) there were no objections taken by either party to the documentary evidence referred to at paragraph 14 below - all that evidence was therefore admitted in the proceedings;

(b) the respondent confirmed that "injury is in dispute but not the fact that the fall alleged to have occurred on 6 January 2025 arose out of or in the course of the applicant's employment with the respondent";

(c) the applicant confirmed that she had not worked since 5 June 2025, and was alleging no current work capacity since then;

(d) the parties agreed that the applicant's unadjusted PIAWE was $2,889.85, and

(e) the parties agreed and accepted that the issues for me to determine in the proceedings were as described at paragraph 8 above.

1. The following documents were in evidence before me and considered by me in making this determination:

(a) the ARD - and attached documents;

(b) the respondent's Reply (Reply) - and attached documents;

(c) the applicant's Application to Lodge Additional Documents dated

17 November 2025 (applicant's first ALAD) - and attached documents;

(d) the applicant's Application to Lodge Additional Documents dated

10 December 2025 (applicant's second ALAD) - and attached documents;

(e) the applicant's Application to Lodge Additional Documents dated

19 December 2025 (applicant's third ALAD) - and attached documents;

(f) the applicant's Application to Lodge Additional Documents dated

15 January 2026 (applicant's fourth ALAD) - and attached documents;

(g) the respondent's Application to Lodge Additional Documents dated

18 December 2025 (respondent's first ALAD) - and attached documents, and

(h) the respondent's Application to Lodge Additional Documents dated

14 January 2026 (respondent's second ALAD) - and attached documents.

1. There was no oral evidence given by any person in these proceedings.

1. The applicant's first statement was signed on 10 October 2025, and it is found at page 1 of the ARD.
2. She completed hospital-based nursing training in 1984, after leaving school in 1980. She had worked as a nurse since, and had worked at Maitland Hospital in this regard since June 2003.
3. She says that she began suffering from pain in both her hips in approximately 2016. In relation to her other medical history, she advises:

(a) in around 1976, she was involved in a motorbike accident, resulting in various fractures;

(b) she had undergone a left total knee replacement in 2014;

(c) she underwent left thumb surgery after injuring her left thumb on or around

27 May 2017;

(d) she began wearing orthotics in December 2018, and

(e) she underwent a right carpal tunnel release and ulna nerve decompression on or around 29 November 2019.

She says that she recovered from these injuries and surgical procedures, so that she was able to continue her nursing work.

1. She then underwent a left total hip replacement on 9 June 2020, following which she "recovered well from this procedure and was able to return to work after approximately 6 weeks". She then underwent a right total hip replacement on 30 September 2024, following which she "recovered well from this procedure and was able to return to work on 3 December 2024". Dr McGrath performed the right total hip replacement, and she says that following the procedure:

"I was worried about infection but my treating specialist, Dr Benjamin McGrath assured me my scans following my surgery were clear and excellent."

1. She advises that while she was working at Maitland Hospital on 6 January 2025, she tripped over a plant root in the hospital's car park. She also advises that as at that date, she "was recovering well from my surgery, so I did not need a walking stick or any assistance".
2. Her right hip was impacted when she tripped, and she felt immediate pain there. She saw her general practitioner on 6 January 2025, and underwent right hip radiological investigations on 7 January 2025, which revealed a large haematoma. She however continued working "in significant pain" until 11 January 2025.
3. On the evening of 11 January 2025, she attended the emergency department of Maitland Hospital and was admitted under Dr Estens. The doctor performed DAIR surgery upon her right hip on 14 January 2025 "to remove the haematoma and treat my right hip infection". She was eventually discharged from hospital on 24 January 2025.
4. Following the discharge, she took intravenous antibiotics for three weeks, and then oral antibiotics for six months. She continued to consult with Dr McGrath.
5. Her right hip pain however continued to worsen, and she had a CT scan of her right hip on 21 August 2025. She then consulted with Dr McGrath on 4 September 2025 and she says:

"Dr McGrath told me that my infection caused the femoral component of my hip replacement to become loose and this is contributing to my pain...Dr McGrath discussed performing a revision right total hip replacement with me...I am scheduled to undergo the revision right total hip replacement on 15 October 2025."

1. She says that her right hip is currently in constant pain, which affects her entire life. She has not worked since 11 January 2025; she struggles to walk and cannot do so without a walking stick; she continues with physiotherapy and hydrotherapy treatment; she cannot run; she cannot use stairs excessively; she struggles to stand for long periods of time; she struggles to sit for long periods of time, and she requires extensive medication.
2. In relation to the respondent's suggestion that her right hip infection would have occurred regardless of her fall on 6 January 2025, she says:

"From my perspective, my hip was recovering well before my fall, and I was pleased with how the operation had went. Prior to the fall, I felt confident in my return to work and was only experiencing minor discomfort in my right hip after walking on concrete floors for an entire shift."

1. The applicant then updates her statement evidence with a statement which she signed on

2 December 2025 - found at page 28 of the applicant's second ALAD. 2. She confirms that she has now undergone the revision right total hip replacement on

15 October 2025, performed by Dr McGrath. She says the surgery "went well" and that her recovery has been "steady". Her ongoing treatment and symptoms include:

(a) she still requires medication - including Targin and Panadol Osteo daily, and Endone as required;

(b) she undertakes a daily physiotherapy program at home - and consults with a physiotherapist fortnightly "for strengthening and further education";

(c) she continues to use ice packs to assist with swelling, bruising and pain;

(d) she continues to use a walking stick on uneven surfaces or when her pain is an "issue";

(e) she rests "as required" and exercises "as instructed" - the distances that she is allowed to walk have steadily increased to "as tolerated";

(f) she still has pain, low muscle tone and strength, as well as slow and decreased mobility, and

(g) she says her pain levels have however decreased "and hopefully will continue to improve so that I can return to my usual lifestyle and my career, which is my greatest hope".

1. Apart from her statement evidence, the applicant also relies upon a schedule of expenses (amounting to $18,195.30) incurred by her (found from page 1 of the applicant's second ALAD). She had also previously attached some invoices to the applicant's first ALAD.
2. I note however that there has been no mathematical agreement between the parties regarding these expenses, nor any submissions by either party in this regard. Indeed, the conclusion section of the applicant's written submissions only seeks an order pursuant to s 60 of the 1987 Act in relation to "the costs of reasonably necessary medical expenses in relation to the right hip and consequential infection". No specific amount is sought in the submissions, and the order proposed is specifically premised on the applicant in the future producing "accounts, receipts, and/or Medicare notice of charge".
3. In those circumstances, in this determination, I do not intend to award the applicant a specific amount in relation to expenses pursuant to s 60 of the 1987 Act. I will be determining the issues for determination (referred to at paragraph 8 above), and I will then make any consequential orders pursuant to s 60 of the 1987 Act in 'general' terms.

1. The applicant's solicitors arranged for her to be medically examined by Professor Ghabrial on 11 September 2025, and his report in this regard dated 11 September 2025 is found at page 16 of the ARD.
2. He obtains a history of her right total hip replacement on 30 September 2024, and that the "procedure went quite well and she returned to work on 3 December 2024".
3. He notes that following the applicant's 6 January 2025 fall, her C-reactive protein (CRP) testing showed a normal reading of 4 on 7 January 2025, but an increased reading to 242 on 11 January 2025 (which he describes as indicating a "severe" infection). He also notes that the applicant's radiological tests on 7 January 2025 revealed a haematoma in her right hip joint region in the soft tissues. He further notes the applicant's surgery with Dr Estens on

14 January 2025, which involved an "evacuation of the haematoma and pus, as well as debridement, and he replaced the lining of the acetabulum". 4. He records the applicant's current CRP testing reading of 3.6, following her need for antibiotics for over six months after the 14 January 2025 surgery. 5. The doctor then records that the applicant continued to have right hip pain following that surgery. She was referred back to Dr McGrath who arranged a CT scan of her right hip in August 2025, which "showed marked loosening of the right hip joint". Dr McGrath discussed performing revision right total hip replacement surgery, which she was planning to undergo (and has since undergone on 15 October 2025). 6. The doctor's examination of the applicant revealed that she "can barely walk, even using a walking stick". She had a marked limp and marked restriction of movement in her right hip. She complained of pain in her groin and anterior right thigh. 7. In relation to causation, the doctor opines:

"She had a procedure to evacuate the haematoma and treat the infection but unfortunately by the time the treatment had finished regarding the infection, the hip had become very loose and needs to be replaced...That procedure is planned for October 2025. I believe that the original surgery in September 2024 went quite well and there was no infection as the CRP level on 7 January 2025 (the day after the fall) was 4, however the infection resulted from the haematoma as a result of the fall on 6 January 2025, and that is the cause of her right hip becoming loose and requiring further hip replacement surgery... I believe that the proposed surgery is reasonable and necessary and has stemmed from the fall on 6 January 2025 due to the sequence of events mentioned earlier in this report."

1. The doctor further opines that the applicant is currently unfit to return to work, and needed re-assessing in this regard six months following the surgery proposed for her by Dr McGrath.
2. There are a number of medical reports from Dr McGrath in the ARD. I do not intend to detail them all, only those that I consider to be relevant and those that (in accordance with cl 67D(2) of the Personal Injury Commission Rules 2021 (the Rules)) I am later referred to in the parties' submissions
3. The doctor's 29 October 2024 report (found at page 157 of the ARD within the clinical notes from Sempill Street Surgery) refers to the applicant having a successful right total hip replacement on 30 September 2024, and she "is going great but does describe a couple of days ago noticing some increased heat and some extra pain around the thigh". He says this has been associated with quite significant activity (walking over 11,000 steps per day). He finds "very little to see" on examination, and orders an ultrasound (which he expects may show a haematoma) as well as CRP testing to determine any infection. He notes that the applicant had started having treatment with antibiotics, but he asked her to cease that treatment for now, pending the CRP testing.
4. The doctor's 31 October 2024 report (found at page 156 of the ARD within the clinical notes from Sempill Street Surgery) records that the applicant has (since 29 October 2024) undergone sequential CRP testing with the readings dropping from 8.8 to 7. He therefore no longer sees the need for the ultrasound that he ordered on 29 October 2024, and he plans to follow-up with the applicant in four weeks. He relevantly and importantly notes that "Kate's CRP is trending down. She says that her thigh is feeling better. This is off antibiotics."
5. The doctor's 2 December 2024 report (found at page 155 of the ARD within the clinical notes from Sempill Street Surgery) does not refer to any CRP testing or potential infection. He notes the applicant's x-rays "looked excellent", and he did not see the need to review her for 10 months.
6. The doctor's 6 February 2025 report (found at page 151 of the ARD within the clinical notes from Sempill Street Surgery) refers to the applicant's recent "very eventful history" with a "pretty nasty infection" - as a result, he does not recommend her undergoing any hydrotherapy or spa treatment at that time.
7. The doctor's 24 February 2025 report (found at page 149 of the ARD within the clinical notes from Sempill Street Surgery) refers to the applicant's CRP testing reading increasing from

4 to 8, and notes that she continues to require antibiotics as well as Endone for her right hip pain. He states:

"I always have the concern when the pain has not settled and the CRP slightly increases that we might not be winning the war against the Staph capitis that she has grown...To reiterate, about eight weeks ago, Kate had a fall, which resulted in her hip joint becoming infected."

1. The doctor's 24 March 2025 report (found at page 147 of the ARD within the clinical notes from Sempill Street Surgery) records the applicant's CRP testing reading as 4. She still however had quite significant inflammation around the right hip area and considerable right hip pain.
2. The doctor's 26 June 2025 report (found at page 146 of the ARD within the clinical notes from Sempill Street Surgery) continues to record the applicant's ongoing right hip inflammation. It notes that the applicant is weaning off her antibiotics. It provides the following opinion in relation to causation:

"I am saddened to hear that Kate has had her WorkCover support withdrawn. I think that this is completely inappropriate...There is no doubt that the hematogenous spread from her fall is the culprit for her current situation. There were no issues of joint problems leading up to the fall. There were no issues with her wound healing. There were no perioperative issues leading up to that point in time. Kate had actually returned to work and walking 20,000 steps a day."

1. The doctor had earlier provided a similar opinion as to causation to the respondent's insurer, in a report dated 24 February 2025 (found at page 30 of the ARD). He explains in that report:

"...it is my clinical opinion that it is possible that Katherine's hip infection could have occurred without the injury. However, this would be very unlikely...The incidence of hip infections is in the order of 1% to 2%. This is very low...There is a very clear chronology association between her fall and the development of her infected joint replacement. My suspicion is that she had an asymptomatic bacteraemia at the time and unfortunately, has had a fall at work at the same time, which has ceded to her hip...I do believe that the injury on 6 January 2025 is a significant attributing factor to the development of the infection. She did not have any pre-existing infection prior to this...The causal link is that the fall onto the right hip region is most likely led to bleeding into that hip joint, and she would have had a concurrent bacteraemia, which she would not have even known about and that has ceded to her hip. This is a recognised mechanism of haematogenous delayed prosthetic infection...Infections that happen beyond the six-week mark are generally related to a secondary injury. Katherine's wound healed fine. She was going well for many months post her initial hip replacement. The fall on 6 January is a very clear associated incident to the development of her right hip infection...With respect to the timeframe for infections, typically around a hip joint replacement, they are usually broken up into early and late. Usually, the early infections will occur in the first 2-6 weeks and then the late infections can happen at any point in time, pending usually an unfortunate sequence of events where there is bleeding into the joint associated with a concurrent bacteraemia...I think the injury sustained on 6 January 2025 caused bleeding, and she would have had a concurrent bacteraemia and that is how she has developed the prosthetic infection. I do not think that the fall exacerbated an underlying infection that was there. There is no evidence that Katherine had an infection that was causing grief in the period leading up to this fall...The manner in which infections like this are treated is the way that it has been treated for Katherine is that they require surgical intervention, which she has already had, which has been a washout and an exchange of the easily exchangeable components, which is called a DAIR. She has had this performed already. This has an efficacy of about 60% with concurrent antibiotic treatment...Sometimes, this fails as it only has a 60% efficiency. Sometimes, treatment needs to be escalated to a removal of all of the implants, and sometimes a spacer can be put in and other times, it may require a third operation to remove the spacer and re-implant a new prosthesis."

1. The next report from the doctor is dated 4 September 2025 (found at page 23 of the ARD). The doctor notes that the applicant's infection is "well under control", with her last CRP testing reading being 3. However, her right thigh pain is worsening and she still requires the assistance of a walking stick. The doctor advises:

"Kathryn has been investigated with a CT scan, which clearly shows that a femoral component is loose. This is the clear explanation for her symptoms. Ultrasound that she has had fails to show an effusion, which would indicate to me that now we have sterile loosening. I suspect that this loosening has been precipitated by her fall and the subsequent in-joint infection that she has had. This has broken the osseointegration around her hip joint and over time, this has been working its way loose."

The doctor sees the only "reasonable step forward" being revision surgery to "remove the femoral components and the modular components and leave the acetabular shell and look at cementing her implants in a single stage". He advises that he will be seeking the approval of the respondent's insurer with regard to this revision surgery as he believes that the need for the surgery is secondary to the applicant's 6 January 2025 fall - "In the absence of having this fall, we would not have found ourselves in this situation".

1. Finally, the doctor provides a report to the applicant's solicitors dated 11 December 2025 (which is found at page 1 of the applicant's third ALAD). The doctor specifically disagrees with opinions (to be discussed below) from Dr Riley, and he provides a detailed explanation for his opinion regarding the causation of the applicant's need for the revision right total hip replacement which he performed upon her on 15 October 2025:

"Firstly, I believe the infection in Ms. Mathews' right hip was a direct consequence of the injury she sustained in a fall on 06/01/2025. My rationale is based on the clear chronology of events. Ms. Mathews underwent a right total hip replacement on 30/09/2024. Her recovery was initially uneventful, as confirmed at her two-week review. At her four-week review on 29/10/2024, she reported increased thigh pain and heat after a substantial increase in her activity levels to 11,000 steps per day. There were no systemic symptoms of infection. Her C-reactive protein (CRP) level was only mildly elevated at 8.3 and subsequently trended down to 7.7 after I ceased a course of antibiotics she had been started on. This is not indicative of an infection but rather a physiological response to excessive loading of a recently operated joint. By her eight-week review, her thigh pain had resolved, her X-ray was satisfactory, and she was progressing exceptionally well, which is inconsistent with a developing infection from the time of surgery...The clinical situation changed dramatically following her fall on 06/01/2025, which occurred after she had recovered sufficiently to return to work. The fall resulted in a haematoma. The day after the fall, her CRP was normal at 4.9, which strongly supports the absence of any pre-existing infection. However, over the subsequent days, her condition deteriorated with the onset of fevers and increasing pain. Her CRP rose dramatically to 244 by 11/01/2025, leading to her hospitalisation. An ultrasound-guided aspiration on 13/01/2025 confirmed an infected haematoma, necessitating a surgical washout on 14/01/2025. This sequence is highly consistent with a secondary infection of a post-traumatic haematoma...Secondly, I believe the revision hip replacement surgery was required as a direct result of the fall on 06/01/2025. Prior to this event, Ms. Mathews had a well-functioning hip replacement. The fall and subsequent infection led to a cascade of events culminating in the failure of her implant. Despite the initial washout and antibiotic treatment, she never regained her pre-fall functional status. The chronic, low-grade infection, established after the fall, caused the gradual loosening of the femoral component of her hip replacement. This became evident in June/July 2025 when she developed increasing thigh pain. This pattern of loosening over a prolonged period is characteristic of an infection-related failure, not loosening from the immediate mechanical impact of a fall. Consequently, she required a revision total hip replacement, which was performed approximately seven weeks ago...In summary, it is my firm medical opinion that Ms. Mathews' recovery from her primary hip replacement was progressing well and without evidence of infection. The fall on 06/01/2025 was the pivotal event, leading directly to an infected haematoma. This infection subsequently caused the loosening of her hip prosthesis, making the revision surgery necessary. I disagree with Dr Riley's conclusions; the chronology of events and laboratory results clearly indicate the infection was a complication of the fall and not a pre-existing issue from her initial surgery."

1. The applicant also relies upon various radiological reports. Again, I do not intend to detail them all, only those that I consider to be relevant and those that (in accordance with cl 67D(2) of the Rules) I am later referred to in the parties' submissions. In this regard, I note the relevance of the following reports:

(a) 12 November 2024 right hip x-ray report (found at page 132 of the ARD within the clinical notes from Sempill Street Surgery) - "Right hip replacement defines normally on x-ray. Alignment is preserved and no acute bodily abnormality is seen on the right";

(b) 11 January 2025 pelvis CT scan report (found at page 185 of the ARD within the clinical notes from Sempill Street Surgery) - "Bilateral THR. No acute periprosthetic fracture...Pelvis is intact. No acute pelvic fracture...Pelvic viscera is unremarkable. No significant soft tissue haematoma...Small region of fluid overlying the right greater trochanter along the incision site and may represent a post-operative seroma";

(c) 11 January 2025 right hip x-ray report (found at page 48 of the ARD) - "Bilateral hip replacements are noted. These appear normally positioned. There is no peri metalware lucency. No effusion is seen. No fracture is seen";

(d) 12 January 2025 pelvis ultrasound report (found at page 184 of the ARD within the clinical notes from Sempill Street Surgery) - "Lateral/posterior to the hip just posterior to the surgical scar there is a complex collection with irregular margins measuring approximately 113 x 45 x 38 mm (103 cc); this volume overestimates the amount of drainable fluid. Some other collection appears anechoic and may be amendable to aspiration. There is some mildly increased vascularity surrounding the collection...Conclusion: Infected collection vs postoperative seroma";

(e) 13 January 2025 right hip region drainage ultrasound report (found at page 184 of the ARD within the clinical notes from Sempill Street Surgery) - "Collection overlying the right hip was aspirated...Collection appeared collapsed at conclusion of procedure";

(f) 14 January 2025 pelvis x-ray report (found at page 127 of the ARD within the clinical notes from Sempill Street Surgery) - "There are dual right sided drains related to the right hip. Extensive periprosthetic loosening surrounding the right acetabulum has been seen on the recent CT performed 3 days earlier";

(g) 19 February 2025 right hip x-ray report (found at page 125 of the ARD within the clinical notes from Sempill Street Surgery) - "There is a bilateral total hip replacement with no periprosthetic lucency or fracture...The joint is enlocated...No other bony or soft tissue abnormality", and

(h) 21 August 2025 pelvis and bilateral hips CT scan report (found at page 26 of the ARD) - "Bilateral total hip replacements are seen in situ and in satisfactory position. No periprosthetic fracture is seen. There is some mild loosening seen surrounding the right femoral shaft when compared with the contralateral side. The remainder of the pelvic ring is intact. There are mild osteoarthritic changes of bilateral sacroiliac joints noted. No significant hip joint effusion is seen. No acute pelvic pathology is demonstrated".

1. The applicant further relies upon various pathology reports. Again, I do not intend to detail them all, only those that I consider to be relevant and those that (in accordance with cl 67D(2) of the Rules) I am later referred to in the parties' submissions. In this regard, I note the relevance of the following reports:

(a) CRP testing recorded (found at page 226 of the ARD within the clinical notes from Sempill Street Surgery) - readings of 8.7 on 19 February 2025, 4.9 on

7 January 2025, 7.7 on 30 October 2024, and 8.3 on 29 October 2024;

(b) CRP testing recorded (found at pages 178-183 of the ARD within the clinical notes from Sempill Street Surgery) - readings of 25 on 21 January 2025, 44 on 19 January 2025, and 244 on 12 January 2025, and

(c) CRP testing recorded (found at page 51 of the ARD) - readings of 4 on

15 April 2025, 6.1 on 18 March 2025, 5.9 on 12 March 2025, and 4.3 on

4 March 2025.

1. In relation to the applicant's treating general practitioner from Sempill Street Surgery,

Dr Booth, there are certificates of capacity in the ARD (between pages 420-437) and in the applicant's fourth ALAD (between pages 1-12). The certificates cover the entire period between 11 January 2025 and 15 February 2026 (save for a brief period between

11 June 2025 and 27 June 2025). The certificates certify the applicant as having no current work capacity during that entire period. The first certificate (dated 19 February 2025) explains in relation to causation - "Kate was leaving work and tripped on a tree root in the carpark causing her to fall onto her right hip. Her hip became bruised which was then complicated by an abscess". The first certificate also explains in relation to pre-existing factors - "Kate had had a hip replacement on 30 September and was back at work on normal duties with normal hours from 3 December 2024". 2. Apart from the certificates of capacity, the ARD also includes the clinical notes from Sempill Street Surgery (from page 93). The clinical notes cover consultations between

20 September 2016 and 30 June 2025. Again, I only intend to detail the consultation notes that I consider to be relevant and those that (in accordance with cl 67D(2) of the Rules) I am later referred to in the parties' submissions. In this regard, I note the relevance of the following:

(a) 16 October 2024 - "had hip replacement 2 weeks ago: knee pain is a lot better, going to work in December: active at home...walking well unassisted";

(b) 28 October 2024 - "R hip replacement...Erythema warmth tenderness distal 1/2 wound. No dc or wound breakdown. T 36.6 forehead...Pain on mobilizing" - ordered the prescription of antibiotics and arranged for the applicant to consult with Dr McGrath the following day;

(c) 21 November 2024 - "feeling good with hip: had concerns about infection but scans were clear: was more some localised bleeding, a bit too active...still away due to get back to work on 3 December";

(d) 6 January 2025 - "ongoing stiffness in right hip...having massage: tight muscles...initially very good post op but has deteriorated in late October and is becoming stiffer: has been doing physio twice a day...increasing stiffness around leg...fall this morning: tripped on a tree root, is now worse" - ordered blood tests for CRP testing as well as a right hip ultrasound;

(e) 5 February 2025 - "had revision of right hip, 4 weeks ago feeling better...Had a staph capitus...slowly improving but not at the same stage as 4 weeks last time...is on antibiotics for 2 weeks: has finished IV yesterday, CRP normal";

(f) 19 February 2025 - "pain is still not settling,: 6 weeks post op: still on targin but not taking when driving...Sees Ben again later in week...still slow to get out of a chair";

(g) 2 May 2025 - "slow improvement over the last few weeks but still has severe pain after lying down and doing stretches";

(h) 21 May 2025 - "CRP was ordered because it had been abnormal in October";

(i) 3 June 2025 - "sees Dr Lewin and Dr McGrath this month: still on keflex 1 g QID, going to exercise physiology...still on targin 5/2.5 BD and occasional endone", and

(j) 30 June 2025 - "is weaning off antibiotics, is trying to reduce targin and endone, is using CBD oil".

1. (I should note at this stage that the ARD also contains clinical notes from East Maitland Physiotherapy and from Maitland Hospital. I have considered these notes, but will only detail them further if (in accordance with cl 67D(2) of the Rules) relevant aspects of them are referred to in the parties' submissions).
2. Finally, the applicant also relies upon the following medical evidence:

(a) Dr Burnton's 12 January 2025 report (found at page 152 of the ARD within the clinical notes from Sempill Street Surgery) - the doctor says that she reviewed the applicant in the emergency department at Maitland Hospital and notes a background of a right total hip replacement, following which there was some new onset pain after 4-6 weeks "which was thoroughly investigated and thought to be due to a haematoma" - the doctor then notes over the past few weeks, the applicant reported worsening pain in her right hip, difficulty weight-bearing, nausea, and fevers - her right hip was warm to touch, CRP testing led to a reading of over 200, and an ultrasound demonstrated a large, multiloculated collection - the doctor diagnoses a periprosthetic joint infection and recommends surgical management with Dr Estens;

(b) an operation report (completed by Dr Sugars - found at page 44 of the ARD) in relation to the DAIR surgery performed upon the applicant by Dr Estens on 14 January 2025 - advising inter alia:

"Hip dislocated. Head removed. Stem well implanted and stable. Space made anteriorly for the femur to be retracted into. Acetabulum prepared and soft tissue excised. Liner removed using specialised tool. Acetabular implants assessed, well implanted and stable. Debridement of tissues undertaken";

(c) Dr Akram's 5 February 2025 report (found at page 150 of the ARD within the clinical notes from Sempill Street Surgery) - the doctor is an infectious diseases consultant - the doctor notes that the applicant underwent DAIR surgery on

14 January 2025 for "right hip early acute prosthetic joint infection" - the doctor was then responsible for providing her with intravenous antibiotics for two weeks - the doctor advises that she responded well to that treatment but still required oral antibiotics for 10 weeks;

(d) Dr Lwin's 26 February 2025 report (found at page 148 of the ARD within the clinical notes from Sempill Street Surgery) - the doctor is also an infectious diseases consultant - the doctor advises that the applicant's primary concern remains her ongoing pain and limited mobility as her CRP testing readings remained "reassuringly low" - the doctor states:

"I discussed with Kate the possibility of requiring a revision if pain and mobility issues persist long-term. She mentioned that Dr McGrath had also suggested this. Having said that, she may still be in the early stage of healing from the surgeries she has had therefore the pain may likely be related to mechanical trauma than persistent infection. Currently, she is on the appropriate targeted antibiotics. I have optimized the dosage to the maximum she can tolerate, but I am not confident that switching antibiotics would alleviate her pain.";

(e) Dr Lwin's 17 March 2025 report (found at page 29 of the ARD) - the applicant was improving gradually, her CRP testing readings were "well suppressed", and she was tolerating her antibiotics without any issues, and

(f) Dr Lwin's 24 June 2025 report (found at page 28 of the ARD) - the applicant was still mobilising with the aid of a walking stick and experiencing intermittent pain - her CRP testing readings were still "well suppressed" and the doctor therefore advised a gradual weaning off of antibiotics.

1. The respondent largely relies upon the opinions of Dr Riley. The doctor has provided two reports in this regard, dated 23 May 2025 (found at page 5 of the Reply) and

26 November 2025 (found at page 1 of the respondent's first ALAD). The doctor only consulted with the applicant once however, on 20 May 2025. 2. In the doctor's first report, he obtains the following history from the applicant:

(a) she landed heavily on her right hip and thigh when she fell on 6 January 2025 - she then suffered significant pain over the lateral aspect of her right hip;

(b) she consulted with Dr Booth later on 6 January 2025 - the doctor ordered CRP testing and a right hip ultrasound;

(c) she continued working on 8 January 2025, on 9 January 2025, and on 10 January 2025 - even though she had pain over the lateral aspect of her right hip and also in her right groin and thigh;

(d) on the evening of 10 January 2025, she experienced symptoms of tiredness, feeling hot, shivering and shaking, as well as increased right hip pain;

(e) she was admitted to Maitland Hospital on 11 January 2025, where she underwent CRP testing, radiological testing, an ultrasound-guided aspiration, and eventually a partial revision right total hip replacement under Dr Estens;

(f) she was discharged from Maitland Hospital on 24 January 2025 - and was then treatment with antibiotics;

(g) she continues with antibiotics treatment and other medications - she is gradually improving, although she still suffers pain over the lateral aspect of her right hip especially after prolonged standing and walking (she gets intense pain after standing or walking for 20 minutes) or prolonged sitting (she has a sitting tolerance of approximately 20 minutes also) - she also suffers right groin and thigh pain - she uses a walking stick whilst outdoors - she has not suffered any recent fevers;

(h) she suffered severe injuries in a motorbike accident in her youth, which eventually led to advanced arthritis in her left knee, for which she underwent a left total knee replacement in 2015 - she advised the left knee prosthesis was satisfactory;

(i) she underwent a left total hip replacement (performed by Dr McGrath) in 2020 - she advised that she recovered without complications and resumed working approximately six weeks post-surgery, and

(j) she underwent a right total hip replacement (also performed by Dr McGrath) on 30 September 2024, with no peri-operative complications - she resumed working on 3 December 2024.

(a) well-healed operation scars in relation to the right hip;

(b) no particular inconsistencies in the applicant's presentation;

(c) some antalgia on the right side;

(d) slight left leg shortening, and

(e) mild tenderness over the right hip greater trochanter.

(a) the applicant's 14 January 2025 operation report - see paragraph 56(b) above;

(b) the applicant's pathology reports - see paragraph 52 above, and

(c) the radiological reports referred to at paragraphs 51(b), 51(c), 51(d), 51(e), and 51(g) above.

"Kate had a right total hip replacement performed by Dr Benjamin McGrath at Lingard Private Hospital on 30th September 2024. Kate made a good recovery following the surgery, resuming employment on 3rd December 2024. Kate suffered a heavy fall onto the lateral aspect of the right hip whilst walking across the Hospital carpark on the morning of 6th January 2025. She presented to the Maitland Emergency Department on 11th January 2025, suffering from a peri-prosthetic joint infection, pathology of which has confirmed a Staphylococcus Capitis. Dr John Estens performed a DAIR procedure on 14th January 2025 and from which Kate is still improving and continues on oral antibiotics."

1. The doctor advises a guarded prognosis. The procedure that the applicant underwent on

14 January 2025 had a success rate of between 40% to 70%, sometimes with continued antibiotic requirement. A full revision replacement could ultimately be required. 2. In relation to causation, the doctor opines:

"Staphylococcus Capitis is a coagulase negative staphylococcus, which is part of the normal skin flora, and is known to cause prosthetic joint infection... Prosthetic joint infections involving Staphylococcus Capitis would rarely, if ever, occur via haematogenous (blood) spread and the organism would either be contracted during surgery or in the early post-operative period. Hence, the micro-organism was present in the right hip joint prior to the work injury and the prosthetic joint infection would have become clinically apparent, regardless of the fall or work injury having occurred...The fall at work caused a soft tissue injury to the lateral aspect of the right hip and this represents the work injury, but was not a substantial contributing factor, to the right hip peri-prosthetic joint infection."

"In the main, coagulase negative staphylococci are less virulent organisms, and this would explain the somewhat delayed presentation...The fall which occurred at work on the morning of 6th January 2025, involved a soft tissue injury to the lateral aspect of the right hip and buttock. As Dr Lwin states, this may have made the infection more apparent, but did not cause the infection. I agree with this statement and opine that the infection would have become clinically evident, whether the fall had occurred or not. Whilst the claimant did suffer an injury to the soft tissues over the lateral aspect of the right hip due to the fall and work injury, the peri-prosthetic joint infection, involved an organism that was in the right hip joint prior to the work injury and gained access either at the time of surgery or otherwise in the few days thereafter. This micro-organism would have caused clinical features of a prosthetic joint infection to present, regardless of the fall having occurred. Hence, employment was not the main contributing factor leading to the occurrence of the prosthetic joint infection."

1. In relation to the applicant's capacity for employment, the doctor advises that she is currently unfit for any work duties, but that this incapacity "is unrelated to the work injury and her incapacity is directly related to the peri-prosthetic joint infection".
2. In the doctor's second report, he reviews further documentation, and answers specific questions posed to him by the respondent's solicitors.
3. The doctor repeats portions of his first report (including parts of the extracts quoted at paragraphs 61, 63, and 64 above) and he specifically refers to reviewing the clinical notes from Sempill Street Surgery - specifically those for 16 October 2024, 28 October 2024,

21 November 2024, and 6 January 2025 (see paragraph 54 above). 4. The doctor opines that the clinical notes (especially on 28 October 2024 and 6 January 2025) support his opinions in his first report. The applicant was prescribed antibiotics on

28 October 2024; she informed Dr Booth on 6 January 2025 of a deteriorating right hip and increasing stiffness there since late October 2024 "which is not consistent with an uncomplicated recovery", and Dr Booth was concerned with regard to the risk of peri-prosthetic joint infection by ordering blood tests on 6 January 2025. The doctor opines:

"The infective organism entered the right hip joint, at the time of the index procedure and by four weeks post-surgery, there was inflammation of the distal half of the right thigh wound and this was suppressed temporarily by the Augmentin Forte antibiotics, but there was progressive stiffness in the tissues around the right hip as documented by Dr Booth and this is all consistent with an ongoing low grade prosthetic joint infection...I disagree with Dr McGrath, regards the causation of the right hip prosthetic joint infection. Dr McGrath, in his report dated 24th March 2025, was of the opinion that the fall caused a haematogenous spread of a sensitive gram-positive coccus. As stated in my previous IME report, haematogenous spread of staphylococcus capitis rarely, if ever, occurs and also very importantly, the documentation from the Sempill Street Surgery confirmed that there were issues with the right hip replacement from the latter part of October 2024 and with progressive stiffness of the tissues over the subsequent two months."

1. The doctor opines that on his review of the radiological evidence, there is no evidence that the applicant's actual fall on 6 January 2025 contributed to the loosening of the femoral component of her hip replacement. The radiological reports prior to her surgery on

14 January 2025 "did not show any peri-prosthetic fracture or any evidence of loosening of either acetabular or femoral component", and the operation report on 14 January 2025 recorded - "Stem well implanted and stable". The doctor opines that "the femoral component has loosened due to ongoing low grade prosthetic joint infection". 2. The doctor agrees that the applicant requires revision hip replacement surgery, but as a result of the prosthetic joint infection, rather than the fall on 6 January 2025. He opines:

"Following the DAIR procedure performed on 14th January 2025, Kate was treated with intravenous Cefazolin for several weeks as per ID physician, Dr Lwin and then was on oral Keflex for six months and this treatment has suppressed the infective organism to some extent but not eradicated the infection and this has caused loosening of the femoral component and the need for revision hip replacement surgery."

1. The respondent otherwise relies upon email correspondence between Laura Walters (from the respondent's insurer), Maitland Hospital, and Dr Lwin - found from page 1 of the Reply. The correspondence appears to contain answers to a number of questions posed to Dr Lwin:

(a) the doctor opines that it is possible that the applicant's hip infection could have occurred without her being injured on 6 January 2025;

(b) the doctor opines:

"I was not the person who saw her at the time of her presentation hence I could not determine the severity of the fall and the subsequent injury. Technically the fall may make the infection more apparent. For example, if the fall was quite severe, then it may promote bleeding into the joint or the wound itself.";

"In my opinion based on the available notes available on the electronic data that I could see, there is no strong supportive evidence that the injury directly caused the infection...There is no strong evidence to say that the injury directly caused the infection but it may exacerbate the infection as I eluted [sic] previously ";

(d) the doctor opines that infections such as the applicant's can occur within three months of surgery or later, depending upon "the culprit organisms";

(e) the doctor advises that he is not aware as to whether there was any evidence of the applicant's infection prior to 6 January 2025;

(f) in relation to the treatment required for the applicant's infection, the doctor opines:

"Infection involving the prosthesis is typically difficult to treat as the bacteria may co-operate deeply into the prosthesis itself. It ususally [sic] requires another open debridement surgery and the exchange of the removable components in the joint as well as long course of antibiotics. About 50%-60% of those infection despite being treated like the above standard therapy can relapse then patients may require more surgeries +/- life long antibiotic suppressions.", and

(g) in relation to whether the applicant's infection could have been present prior to her 6 January 2025 fall, the doctor advises that "when infection exactly occurs is difficult to ascertain".

1. The applicant has provided written submissions dated 29 January 2026. The submissions therefore form part of the Commission's record, and I will not summarise them in detail.
2. The applicant first refers to her statement evidence and the radiological findings revealing a haematoma (see paragraph 51(d) above). There can be no doubt that the haematoma, her fall on 6 January 2025, and the symptoms that she complained about immediately thereafter, constitute an injury pursuant to s 4 of the 1987 Act - she relies upon Galluzzo v Commonwealth Bank of Australia [2014] NSWWCCPD 82 (Galluzzo) and Kennedy Cleaning Services Pty Ltd v Petkoska [2000] HCA 45 (Petkoska).
3. The applicant emphasises her recorded CRP testing (see paragraph 52 above) and submits:

"When at hospital on 12 January 2025, 6 days following the fall, the applicant's CRP measured 244mg/l. As at the date of the fall, it measured 4.9 mg/l. This represents a substantial increase in the biomarker associated with infection, only 6 days following the fall. The applicant submits this establishes a direct correlation between the fall and the development of the infection and becomes critical when one weighs up the evidence in this matter. It strongly favours the applicant's evidence as will be developed below. When considered objectively, the pathology is at odds with there being a coincidental uptick in the infection, which appears to be the respondent's case. The clear precipitating factor is the fall...The CRP results measured lowest on the day of the fall, indicating no infection was present at that time. Indeed, concern about infection is a natural consequence of any surgery. The treatment records reveal a level of concern, which is to be expected, but do not reveal any actual infection. There is a total absence of evidence of infection prior to the fall in this case."

1. The applicant describes the CRP testing records as underpinning the evidence provided by Professor Ghabrial and Dr McGrath. She refers to the extract from Professor Ghabrial's report quoted at paragraph 38 above, as well as the extracts from Dr McGrath's reports quoted at paragraphs 48 and 50 above. She notes that Dr McGrath is best placed to provide opinions regarding her right hip condition, as he managed her treatment for the condition.
2. She criticises Dr Riley's reports on the following bases:

(a) while the doctor considers the CRP testing records, he does not "explore or address the correlation between the fall and the significant increase in the CRP reading";

(b) the doctor places heavy reliance upon Dr Lwin's email (see paragraph 64 above) in circumstances where Dr Lwin was clearly hesitant in expressing opinions, due to his reliance on electronic data and due to his inability to determine the severity of the applicant's fall, having not seen her at the time (see paragraph 71 above) - it is also not clear as to the degree to which Dr Lwin had the applicant's CRP testing records available - further, the extract from Dr Lwin's email quoted at paragraph 71(b) requires consideration in that:

"He [Dr Lwin] is not saying that the fall did not contribute to the infection, which is Dr Riley's unsustainable view of the matter. He is referring to the direct cause of the infection. The 'direct cause' of the infection is not the question before the Commission. The fall only needs to be a cause, not the primary cause. Thus, the evidence should be understood to say that the fall triggered the infection (which on the pathology was inactive at the time of the fall).", and

(c) the doctor's opinion is internally inconsistent - in relation to the extract from his first report quoted at paragraph 63 above:

"On the one hand, he says that staphylococcus capitis is part of the normal skin flora, which provides a coherent explanation for how the fall, haematoma and internal bleeding triggered the infection, noting no skin break occurred. On the other hand, he opines that the organism was contracted during surgery or in the early post-operative period. He makes this leap without identifying any evidence which demonstrates that the organism was contracted during surgery (noting he ignores the pathology results). His opinion can be reduced to speculation."

1. The applicant then summarises by referring to Kooragang Cement Pty Ltd v Bates (1994) 35 NSWLR 452 (Kooragang), Kumar v Royal Comfort Bedding Pty Limited [2012] NSWWCCPD 8 (Kumar), Moon v Conmah Pty Limited [2009] NSWWCCPD 134 (Moon), and Murphy v Allity Management Services Pty Limited [2015] NSWWCCPD 49 (Murphy). Applying a commonsense evaluation of the chain of causation - the applicant's fall on 6 January 2025 resulted in a haematoma, and that then resulted in the activation of an infection (not present earlier according to Dr McGrath and the relevant CRP testing), and that then materially contributed to the applicant's need for her revision surgery on 15 October 2025.
2. The applicant should therefore be entitled to payment of her treatment expenses in relation to her right hip injury and her consequential infection. She should also be entitled to weekly compensation benefits from 23 June 2025 on an ongoing basis, as she has been totally incapacitated for employment since then. She emphasises in this regard the following evidence:

(a) the symptoms and restrictions referred to in her statement evidence - see paragraph 28 above;

(b) Professor Ghabrial's opinion (see paragraph 39 above) that her ability to return to work could only be assessed six months following her revision surgery on

15 October 2025;

(c) the certificates of capacity from Dr Booth (see paragraph 53 above) certify her with no current work capacity;

(d) the lack of any evidence suggesting "any real work that the applicant can perform", and

(e) Dr Riley's opinion as to her inability to work - see paragraph 65 above.

1. The respondent has provided written submissions dated 13 February 2026. The submissions therefore form part of the Commission's record, and I will not summarise them in detail.
2. The respondent concedes that the applicant suffered a fall on 6 January 2025 which resulted in a soft tissue injury. It argues however that the loosening of the femoral component of the applicant's right hip replacement was due to an infection that was neither caused by nor contributed to by the fall. The growth of the infection pre-dated the fall, and the infection would have caused the loosening irrespective of the fall. The revision surgery that the applicant underwent on 15 October 2025 was only necessary because of the infection. Further, any incapacity for work of the applicant's is also only a result of the infection.
3. The respondent refers to the opinions of Professor Ghabrial (see paragraph 38 above) and Dr Riley (see paragraph 69 above) which support the infection as being the cause of the loosening of the applicant's hip replacement, rather than any soft tissue injury or haematoma suffered by the applicant in the fall.
4. The respondent then in effect submits that the opinions of Dr Riley should be preferred to the opinions of Professor Ghabrial and Dr McGrath, regarding "the infection would have become clinically evident irrespective of the fall". The fall did not substantially contribute to the infection - see the extract from Dr Riley's first report quoted at paragraph 63 above.
5. In relation to Dr McGrath's opinions, the respondent emphasises:

(a) he accepts the possibility that the infection could have occurred independent of the fall - see paragraph 48 above;

(b) his opinion that (following her right total hip replacement surgery on 30 September 2024) "there were no issues of joint problems leading up to the fall" (see paragraph 47 above) fails to take into account:

(i) the history taken by Dr Burnton (see paragraph 56(a) above) that the applicant suffered right hip pain approximately four to six weeks after the surgery, which was investigated and thought to be due to a haematoma;

(ii) the history taken by the applicant's physiotherapist (in a report dated 7 April 2025 and found at page 79 of the ARD) that following the surgery her "progress initially was OK but she noticed increased discomfort in November and then she had a fall leaving work in the carpark onto her operated hip on 11/12/2024 after working 3 consecutive night shifts";

(iii) the applicant's complaints to her general practitioner on 28 October 2024 - see paragraph 54(b) above;

(iv) the applicant's history of right hip deterioration since late October 2024 - given to her general practitioner on 6 January 2025 (see paragraph 54(d) above);

(v) the history recorded by the applicant's general practitioner of an "abnormal" CRP testing recording in October 2024 - see paragraph 54(e) above;

(vi) the history in his 31 October 2024 report (see paragraph 42 above) regarding increased CRP testing readings at the time, and

(vii) the history in his 29 October 2024 report (see paragraph 41 above) - following which he ordered CRP testing;

(c) he "appears to have later formed a fixed view that the applicant's fall was the cause of later infection, disregarding evidence of earlier signs of infection", and

(d) he is not a "disinterested observer" and is not in a position to provide an objective view as to causation, due to being "naturally interested in the outcome of his work being without infection or other complication".

1. In relation to Professor Ghabrial's opinions, the respondent emphasises that the history provided to him was that the applicant's surgery on 30 September 2024 "went quite well" (see paragraph 33 above). It therefore appears that he had incomplete information as he was unaware of the histories referred to at paragraph 83(b) above.
2. The respondent also submits:

(a) the timeline for the development of the applicant's infection is consistent with

Dr Riley's opinions regarding its delayed presentation - see paragraph 64 above;

(b) it is unsurprising that the applicant's CRP testing recordings were in the normal range in late 2024, considering that she was placed on antibiotics in late October 2024, and

(c) in accordance with Murphy, the applicant has not met its burden in proving that any injury sustained by her on 6 January 2025 materially contributed to the need for her surgery on 15 October 2025.

1. In relation to the applicant's claim pursuant to s 60 of the 1987 Act, the respondent then specifically advises that it "does not submit the surgery claimed was an unreasonable medical intervention for the applicant's presenting clinical issues". However, the respondent confirms its submissions that the surgery was to address issues arising from the applicant's infection, and that the infection was not caused or contributed to by the applicant's employment.
2. Finally, in relation to the applicant's claim for weekly benefits compensation, the respondent submits that any incapacity of the applicant's for work "is also related to the pain and effects of the infection, including recovery from revision surgery". Whilst the applicant may have a present incapacity for work, it does not result from any injury arising out of or in the course of employment.

1. The applicant has provided written submissions in reply dated 16 February 2026. The submissions therefore form part of the Commission's record, and I will not summarise them in detail.
2. Relevantly, the applicant points out:

(a) there is nothing remarkable about the evidence of right hip symptomatology referred to by the respondent at paragraphs 83(b)(i)-(iv) above - considering that the applicant had undergone a right total hip replacement on 30 September 2024;

(b) the respondent is incorrect that the applicant was taking antibiotics after

29 October 2024 - Dr McGrath told her to cease taking them on that date - see paragraph 41 above;

(c) Dr McGrath's 31 October 2024 report (see paragraph 42 above) states that the applicant's CRP testing recordings were trending down even though she was not taking antibiotics - this supports the proposition that there was no evidence of any infection prior to her fall on 6 January 2025;

(d) the respondent has made submissions akin to saying Dr McGrath is biased (see paragraph 83(d) above) - there is no reasonable basis for this submission, especially as Dr McGrath has not been cross-examined or been given the opportunity to respond;

(e) Professor Ghabrial was in fact "fully informed of the issues in the case" - as the evidence demonstrates that the applicant's CRP testing recordings were trending down even though she was not taking antibiotics, and

(f) no evidence has been identified at all by the respondent proving that an infection existed prior to the applicant's fall on 6 January 2025.

Did the applicant sustain an injury to her right hip on 6 January 2025, in accordance with ss 4 and 9A of the 1987 Act

1. I find the respondent's position to be unclear regarding this issue. It advised (see paragraph 13(b) above) at the conciliation/arbitration on 13 January 2026 that injury was in dispute. However, in its written submissions (see paragraph 80 above), it conceded that the applicant suffered a fall on 6 January 2025 which resulted in a soft tissue injury. There was no dispute that the fall arose out of or in the course of the applicant's employment with the respondent (see paragraph 13(b) above).
2. Dr Riley's evidence is also that the applicant suffered "an injury to the soft tissues over the lateral aspect of the right hip due to the fall and work injury" (see specifically paragraph 64 above).
3. 'Injury' is defined in s 4 of the 1987 Act as follows:

(a) personal injury arising out of or in the course of employment,

(b) includes a 'disease injury', which means:

(i) a disease that is contracted by a worker in the course of employment but only if the employment was the main contributing factor to contracting the disease, and

(ii) the aggravation, acceleration, exacerbation or deterioration in the course of employment of any disease, but only if the employment was the main contributing factor to the aggravation, acceleration, exacerbation or deterioration of the disease".

"A 'personal injury' is 'a sudden and ascertainable or dramatic physiological change or disturbance of the normal physiological state' (Kennedy Cleaning Services Pty Ltd v Petkoska [2000] HCA 45; 200 CLR 286 per Gleeson CJ and Kirby J at [39]). The Commission has consistently applied this statement (North Coast Area Health Service v Felstead [2011] NSWWCCPD 51 from [79] (Felstead)). Moreover, as was explained in Felstead (at [81]), to constitute a personal injury, such a physiological change or disturbance change 'may be as simple as a bruise or a soft tissue strain'".

1. In Trustees of the Society of St Vincent de Paul (NSW) v Maxwell James Kear as administrator of the estate of Anthony John Kear [2014] NSWWCCPD 47 (Kear), Roche DP further advised (at [60]):

"In any event, the authorities do not support the proposition that, on its own, an elevation in blood pressure is a personal injury. That is because, without more, it is not a sudden and ascertainable or dramatic physiological change or disturbance of the normal physiological state. It is no more than a temporary physiological change in the body's functioning, similar to the atrial fibrillation that occurred in Castro, without any accompanying lesion or pathological change (Castro at [138])."

1. In accordance with Galluzzo and Kear (as well as numerous other authorities), the applicant's right hip soft issue injury on 6 January 2025, which is conceded by the respondent and accepted by Dr Riley, is sufficient to amount to a sudden and ascertainable or dramatic physiological change or disturbance of the normal physiological state. She has therefore sustained an injury in accordance with s 4 of the 1987 Act, and I so find.
2. I also find that the applicant's employment with the respondent was a substantial contributing factor to the right hip injury sustained by her in her fall on 6 January 2025, in accordance with s 9A of the 1987 Act. I note in this regard that the respondent did not specifically submit otherwise.
3. Section 9A(1) of the 1987 Act relevantly provides:

"No compensation is payable under this Act in respect of an injury (other than a disease injury) unless the employment concerned was a substantial contributing factor to the injury."

1. Sub-section (2) of s 9A of the 1987 Act provides examples of matters to be taken into account in determining whether employment was a substantial contributing factor. The list, which is not exhaustive, has six examples:

(b) the nature of the work performed and the particular tasks of that work;

(d) the probability that the injury or a similar injury would have happened anyway, at about the same time or at the same stage of the worker's life, if he or she had not been at work or had not worked in that employment;

(e) the worker's state of health before the injury and the existence of any hereditary risks, and

(f) the worker's lifestyle and his or her activities outside the workplace.

1. Whether employment is a substantial contributing factor to an injury is a question of fact and is a matter of impression and degree (Dayton v Coles Supermarkets Pty Ltd [2001] NSWCA 153 at [29]) to be decided after a consideration of all the evidence.
2. The applicant's injury occurred as a result of a fall which occurred during the course of her employment with the respondent when she tripped over a plant root on the respondent's premises. The fall happened while the applicant was at work, and there is no indication in the medical evidence that her previous right hip disabilities or her previous state of health or indeed her lifestyle, contributed to the fall occurring. Considering the matters provided in s 9(2) of the 1987 Act, there does not seem to be any doubt that the applicant's employment was a substantial contributing factor to her fall on 6 January 2025 in which she sustained her right hip injury.

Did the applicant sustain a consequential infection in her right hip, resulting from the injury sustained by her on 6 January 2025

1. This is the issue that the respondent especially disputes.
2. It is important at the outset to establish the relevant test for determining the presence of a consequential condition. In this regard, in Kumar, Roche DP (at [46-48]) provided a useful summary of what was said by Kirby P in Kooragang:

"Kirby P (as his Honour then was) said (at 461G) (Sheller and Powell JJA agreeing) that '[f]rom the earliest days of compensation legislation, it has been recognised that causation is not always direct and immediate'. After referring to earlier English authorities, his Honour added (at 462E):

'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.'

'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.'

His Honour concluded that the Court was left with 'an unbroken chain of undisputed evidence'. In combination, the facts went 'beyond mere predisposing circumstances'. They combined to make it 'proper to reach the conclusion that the death of the worker 'resulted from' his original injury and all of the consequences which it set in train'. His Honour did not find that the heart attack was a s 4 injury, but confirmed the trial judge's finding that the heart attack on 8 June 1992 resulted from the accepted back injury in 1981."

1. In Moon, Roche DP (at [44-45]) then stated:

"The evidence in support of this allegation is brief but clear. It is obvious that Mr Moon has experienced significant restrictions in the use of his right arm and shoulder for several years. It is not disputed that that restriction has resulted from his employment with Conmah. As a result, he has used his left arm and shoulder to compensate for his right shoulder condition. Therefore, Mr Moon is claiming compensation for a consequential loss. That is, a loss or impairment that he alleges has resulted from his previous compensable injury to his right shoulder (see Roads & Traffic Authority (NSW) v Malcolm (1996) 13 NSWCCR 272).

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. As discussed in Moon, what the applicant has to establish in these proceedings is that her right hip infection (which was diagnosed following her admission to Maitland Hospital on 11 January 2025) resulted from the right hip injury which I have found occurred when she fell on

6 January 2025. Whether the applicant can establish this is (as noted by Kirby P in Kooragang) a question of fact to be determined following a "commonsense evaluation of the causal chain" on the basis of the evidence, specifically the medical evidence. 2. In my opinion, the temporal relationship between the right hip infection being diagnosed five days after the fall where the right hip was injured is a significant "commonsense" consideration, when evaluating the relevant causal chain. 3. I accept that prior to her fall on 6 January 2025, the applicant was progressing well following her right total hip replacement on 30 September 2024. She had returned to work for the respondent on 3 December 2024 and says (see paragraph 19 above) that she had "recovered well", although she had been concerned about an infection earlier. 4. I have no reason not to accept the applicant's statement evidence. 5. Her treating surgeon in relation to her right total hip replacement on 30 September 2024,

Dr McGrath, also confirms the applicant's recovery. When he saw her on 2 December 2024 (see paragraph 43 above), he did not see the need to review her for another 10 months. Her x-rays "looked excellent" according to the doctor. The 12 November 2024 x-ray report in this regard (see paragraph 51(a) above) confirms no abnormalities. 6. Dr McGrath had earlier, in late October 2024 (see paragraphs 41-42 above), been concerned about the possibility of a right knee infection due to the applicant's CRP testing readings being up to 8.8. Nevertheless and importantly, he specifically advised the applicant not to take antibiotics, and her CRP testing readings still dropped within two days. He did not therefore see the need for further treatment in this regard when he consulted with the applicant on 31 October 2024. 7. The applicant's CRP testing readings are discussed at paragraph 52 above. The readings had dropped to 7.7 on 30 October 2024, and 4.9 on 7 January 2025. They then rose in what can only be considered to be an extremely dramatic fashion, to 244 on 12 January 2025. 8. The records from the applicant's general practitioner (see paragraphs 53-54 above) also confirm:

(a) the applicant was working normal hours and normal duties with the respondent from 3 December 2024, and

(b) the applicant was "feeling good with hip" on 21 November 2024 - she advised the doctor that her concerns about an infection had not materialised.

1. It is also to be noted however that the applicant complained to her general practitioner on

6 January 2025 of increasing ongoing right hip stiffness. The doctor further notes that the applicant's condition deteriorated in late October 2024, but this is entirely consistent with her consultations with Dr McGrath at that time (see paragraph 109 above). 2. In its submissions, the respondent emphasises (see paragraph 83(b) above) the increasing ongoing right hip stiffness recorded by the general practitioner on 6 January 2025, as well as the histories provided by the applicant to Dr Burnton on 12 January 2025 and to her physiotherapist (as recorded on 7 April 2025). The respondent also emphasises the treatment which the applicant received in late October 2024. 3. As noted however, the applicant's issues in late October 2024 resolved speedily and without ongoing complication or the need for antibiotics. Further, in my opinion, the increasing right hip stiffness noted by her general practitioner on 6 January 2025 as well as the history recorded by her physiotherapist of increasing right hip discomfort since November 2024, are not necessarily inconsistent with the applicant progressing well following what was significant right hip surgery which had been undertaken by her only a few months prior. The applicant herself says (see paragraph 26 above) that she continued to experience minor discomfort prior to her fall on 6 January 2025, but that she was otherwise confident to return to work and "pleased with how the operation had went". In any case, any stiffness and discomfort of the applicant's in this regard is not in my opinion indicative of an infection being about to develop, especially considering the applicant's CRP testing reading of 4.9 on 7 January 2025. 4. Of more concern is the history taken by Dr Burnton at Maitland Hospital on 12 January 2025 (see paragraph 56(a) above) of worsening right hip pain, nausea and fevers "over the past few weeks". This recording of nausea and fevers for a few weeks is however totally inconsistent with the other contemporaneous medical evidence, especially considering the applicant's CRP testing reading of 4.9 on 7 January 2025. It appears in this regard that Dr Burnton only consulted with the applicant once (when she attended the emergency department at Maitland Hospital), and it is not clear as to whether the doctor obtained any historical or clinical information about her from either Dr McGrath or her treating general practitioner. In accordance with Mason v Demasi [2009] NSWCA 227, I do not afford the doctor's recording significant weight, considering the doctor's limited experience in treating the applicant, as well as the circumstances in which the doctor treated the applicant at a busy hospital emergency department. 5. Considering the contemporaneous medical evidence overall in relation to the applicant's right hip condition between 30 September 2024 and 6 January 2025, I am satisfied that the applicant was recovering well from her right total hip replacement (and that there were no signs or symptoms of any infection) as at the date of her fall on 6 January 2025. 6. I accept the applicant's submission (see paragraph 74 above) that concern about infection is a natural consequence of any surgery, and that the contemporaneous records following the applicant's right total hip replacement surgery on 30 September 2024 therefore reveal this concern, but also do not reveal any actual infection. 7. The temporal relationship between the applicant's right hip infection diagnosis and her fall on 6 January 2025 is of course not the only evidence providing a causative link between the fall and the infection. 8. There is very powerful and compelling reasoning provided by Dr McGrath in this regard. I have quoted extensively (see especially paragraphs 48 and 50) from the doctor's reports as a result. The doctor's reasoning refers to and is consistent with the contemporaneous medical evidence (which was largely driven by him in any case) and it provides the chain of causation referred to in Kooragang. Specifically:

(a) the applicant's issues in late October 2024 were not indicative of an infection but rather a physiological response to excessive loading of her right hip;

(b) the applicant was progressing exceptionally well when the doctor reviewed her eight weeks after her right total hip replacement surgery - which is inconsistent with a developing infection;

(c) the applicant's CRP testing reading of 4.9 on 7 January 2025 strongly supports the absence of any pre-existing infection;

(d) the fact that the applicant's CRP testing reading then rose to 244 is highly consistent with a secondary infection of a post-traumatic haematoma;

(e) the applicant's fall on 6 January 2025 was therefore "the pivotal event", leading directly to an infected haematoma;

(f) the fall did not exacerbate an underlying infection - it caused bleeding into the hip joint associated with a concurrent asymptomatic bacteraemia, and

(g) infections which occur over six weeks after surgery are generally related to a secondary injury.

1. In relation to the respondent's submissions regarding Dr McGrath's reasoning (see paragraph 83 above):

(a) while the doctor accepts the possibility that the right hip infection could have occurred independent of the applicant's fall, he opines that "this would be very unlikely" - see paragraph 48 above;

(b) the doctor has fully explained his opinion regarding the applicant not experiencing an infection in late October 2024 - see paragraph 50 above, and

(c) I reject the submission that the weight to be given to the doctor's reasoning is affected by him being the applicant's treating doctor - I in fact give significantly more weight to his reasoning on account of him being the applicant's treating doctor - he is clearly in this regard in the best position to discuss how the applicant's treatment was progressing after her right total hip replacement surgery on 30 September 2024 - he performed the surgery and he then consulted with her on at least four occasions between that date and the date of the applicant's fall.

1. Dr McGrath's opinions regarding the causal link between the applicant's right hip infection and her 6 January 2025 fall, are also consistent with Professor Ghabrial's opinion (see paragraph 38 above) that "the infection resulted from the haematoma as a result of the fall on 6 January 2025".
2. The respondent essentially relies upon Dr Riley's opinions to counter the causative link between the applicant's right hip infection and her fall on 6 January 2025. In this regard, I do not place much weight upon Dr Lwin's email (see paragraph 71 above). The email is not in the form of a signed medical report and it provides vague and hesitant statements relying upon "notes available on the electronic data". It opines that there is "no strong supportive evidence that the injury directly caused the infection" (which is not in any case the test that I need to consider in accordance with Kooragang), but it also advises that "if the fall was quite severe, then it may promote bleeding into the joint or the wound itself", making the infection more apparent. Overall, it concludes that when the applicant's infection exactly occurred was difficult to ascertain. I accept the applicant's submissions (see paragraph 76(b) above) regarding the limitations in relying upon Dr Lwin's email.
3. In relation to Dr Riley's opinions, I appreciate the reasoning provided by the doctor (see especially paragraphs 63, 64, and 68 above) but I prefer the opinions in relation to causation provided by Dr McGrath. In this regard:

(a) I place weight upon Dr McGrath being the applicant's treating doctor, who consulted with her on at least four occasions after her right total hip replacement on 30 September 2024, and was therefore well acquainted with her treatment progress in this period - in contrast, Dr Riley only had the opportunity to consult with the applicant once, on a date (20 May 2025) many months after both the right total hip replacement and the applicant's 6 January 2025 fall;

(b) I place weight upon the support provided by Professor Ghabrial to Dr McGrath's opinions;

(c) I find it difficult to accept Dr Riley's opinion that the applicant's infection (see paragraph 64 above) "involved an organism that was in the right hip joint prior to the work injury and gained access either at the time of surgery or otherwise in the few days thereafter" - in circumstances where the applicant's CRP testing readings after her right total hip replacement surgery on 30 September 2024 only rose to a highest reading of 8.8 in late October 2024 (compared with 244 at the time when the infection was diagnosed after the applicant's fall on 6 January 2025) - Dr McGrath's opinion that there was no infection prior to the fall is more consistent with the contemporaneous evidence;

(d) I accept the applicant's submission (see paragraph 76(a) above) that Dr Riley has not explained the significance (or lack of significance) of the applicant's low CRP testing readings prior to her fall on 6 January 2025, when compared with the reading of 244 a few days after the fall;

(e) Dr Riley's conclusions are affected by his opinion that the applicant did not have an uncomplicated recovery from her right total hip replacement surgery on 30 September 2024 (see paragraph 68 above) - this opinion is contrary to my finding at paragraph 116 above, and

(f) importantly, the history that Dr Riley takes regarding the applicant's use of antibiotics in late October 2024 temporarily suppressing an infection (see paragraph 68 above) is incorrect, as the applicant was told by Dr McGrath to cease using antibiotics on 29 October 2024 (see paragraph 41 above) -

Dr McGrath then notes on 31 October 2024 (see paragraph 42 above) that the applicant's CRP readings were trending down without the use of antibiotics.

1. In Nguyen v Cosmopolitan Homes [2008] NSWCA 246 (Nguyen), McDougall SCJ (with whom McColl JA and Bell JA agreed) referenced an article by Hodgson SCJ and stated (at [51-52]):

"In the later article, Hodgson J suggested that the two approaches could be combined. He did so in a way that, I think, is consistent with what I have said above as to Malec. He said at 732 that 'if, on the basis of adequate material concerning circumstances of a particular case, the tribunal [of fact] believes that an event has occurred, with the strength of that belief being at least such as would be indicated by a probability in excess of 50%, then the civil onus is discharged'. Thus, his Honour adhered to the requirement of a feeling of actual persuasion. But he made it plain that, once the feeling has been obtained, it is sufficient for it to lead to the conclusion that the event in question is more likely than not to have occurred, with 'a probability in excess of 50%'.

In my view, that is the approach that should be adopted in the resolution of disputed questions of fact. It is something of particular significance where a resolution of the disputed question depends upon the drawing of inferences from entirely circumstantial evidence. It also accommodates the requirement that attention be paid to the seriousness of the fact in issue, or the consequences of finding that it has occurred."

1. Roche DP discussed Nguyen in Drca v KAB Seating Systems Pty Ltd [2015] NSWWCCPD 10 (Drca) (at [104-105]):

"A mere mechanical comparison of probabilities, independent of a reasonable satisfaction, will not justify a finding of fact. The fact finder must feel 'an actual persuasion of the occurrence or existence of the fact in issue before it can be found' (Redlich JA, Harper JA and Curtain AJA in NOM v DPP [2012] VSCA 198 at [124]; see also Dixon J in Briginshaw v Briginshaw [1938] HCA 34; 60 CLR 336 and Dixon, Evatt and McTiernan JJ in Helton v Allen [1940] HCA 20; (1940) 63 CLR 691 at 712).

Once the feeling of actual persuasion has been obtained, 'it is sufficient for it to lead to the conclusion that the event in question is more likely than not to have occurred, with 'a probability in excess of 50%' (McDougall J (McColl and Bell JJA agreeing) at [51] in Nguyen v Cosmopolitan Homes [2008] NSWCA 246)."

1. In accordance with Nguyen and Drca, and relying upon the opinions of Dr McGrath and Professor Ghabrial, as well as the contemporaneous evidence regarding the recovery of the applicant from her 30 September 2024 right total hip replacement, I feel the actual persuasion necessary to find what I consider to be a commonsense causal connection between the applicant's fall on 6 January 2025 and the subsequent development of her right hip infection. In my opinion, the infection resulted from the injury sustained in the fall.

Is the applicant entitled to an award pursuant to s 60 of the 1987 Act, specifically in relation to the costs of and incidental to the revision right total hip replacement surgery performed upon her by Dr McGrath on 15 October 2025

1. Having found that the applicant's right hip infection resulted from her injury on 6 January 2025, the overwhelming medical evidence supports that the infection was then responsible for the loosening of the femoral component of her right hip replacement (that she underwent on 30 September 2024).
2. The overwhelming medical evidence also supports that the revision total right hip replacement surgery that the applicant underwent on 15 October 2025 was reasonably necessary treatment to counter the loosening of the femoral component.
3. Indeed, it seems that the respondent accepts these connections (see its submissions at paragraphs 80 and 86 above), specifically advising that it does not submit that the applicant's revision total right hip replacement surgery was unreasonable medical intervention for her presenting clinical issues.
4. In relation to the evidence:

(a) the applicant says that her right hip pain continued to worsen following the DAIR surgery upon her right hip on 14 January 2025 - as at the date of her 10 October 2025 statement, she was in constant pain, struggling to walk, and requiring extensive medication - her entire life was affected - see paragraph 25 above;

(b) Professor Ghabrial (who examined the applicant on 11 September 2025) notes that she could barely walk, had marked restriction of right hip movement, as well as pain in her groin and right thigh - he reviews her 21 August 2025 CT scan which showed "marked loosening of the right hip joint" - he opines that the infection was the cause of the loosening and that further right total hip replacement surgery was needed - see paragraphs 36-38 above;

(c) the 21 August 2025 CT scan report (see paragraph 51(h) above) refers to "mild loosening seen surrounding the right femoral shaft when compared with the contralateral side";

(d) Dr McGrath (in his 24 February 2025 report - see paragraph 48 above) advised at an early stage that the applicant's 14 January 2025 DAIR surgery only had a 60% "efficiency" - further surgery was certainly foreseen by him at that stage;

(e) Dr McGrath continues to consult with the applicant throughout 2025 - due to the applicant's ongoing right hip symptoms, he orders the 21 August 2025 CT scan - he then (in his 4 September 2025 report - see paragraph 49 above):

(i) notes the applicant's worsening right thigh pain and walking issues - despite her infection then being under control;

(ii) notes the loose femoral component shown in the CT scan - as being the explanation for her ongoing symptoms;

(iii) opines that the loosening was precipitated by her 6 January 2025 fall and her subsequent infection - which broke "the osseointegration around her hip joint and over time, this has been working its way loose", and

(iv) opines that the only "reasonable step forward" is revision right total hip replacement surgery;

(f) Dr Lwin (in a report dated 26 February 2025 - see paragraph 56(d) above) also advised at an early stage "the possibility of requiring a revision if pain and mobility issues persist long-term";

(g) Dr Riley (noting that he examined the applicant on 20 May 2025) advised a guarded prognosis as the 14 January 2025 DAIR surgery only had a success rate of between 40% to 70% - he advised that revision replacement surgery could ultimately be required - see paragraph 62 above, and

(h) Dr Riley's clear opinion in relation to the cause of the loosening of the applicant's femoral component is that it was her infection (see paragraphs 69-70 above) - the doctor then opines as to the need for the applicant to undergo revision hip replacement surgery as a result - these opinions of course are entirely consistent with the opinions of Dr McGrath and Professor Ghabrial.

1. Having found that the applicant's 6 January 2025 injury resulted in her infection, I now find that the infection resulted in the loosening of her previous right total hip replacement. There is in fact no medical evidence to the contrary.
2. In Murphy, Roche DP stated (at [58]):

"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)."

1. The medical evidence is also unanimous that the revision right total hip replacement surgery undergone by the applicant on 15 October 2025 was reasonably necessary because of the loosening of her previous right total hip replacement (which resulted from the infection, and which in turn resulted from the 6 January 2025 injury). There is an unbroken chain of causation in this regard, and I therefore find that the injury materially contributed to the need for the revision right total hip replacement surgery on 15 October 2025.
2. In accordance with paragraphs 29-31 above, as there has been no mathematical agreement between the parties regarding the medical treatment expenses related to the applicant's infection and her 15 October 2025 revision right total hip replacement surgery, I propose to make a 'general' order that the respondent pay the applicant's costs of and incidental to her treatment for the infection, and for her 15 October 2025 surgery, in accordance with s 60 of the Act.

Is the applicant entitled to weekly benefits compensation from 5 June 2025 to date and continuing, pursuant to s 37 of the 1987 Act - if so, what weekly amount should be awarded to her in this regard

"(1) The weekly payment of compensation to which an injured worker who has no current work capacity is entitled during the second entitlement period is to be at the rate of 80% of the worker's pre-injury average weekly earnings.

(2) The weekly payment of compensation to which an injured worker who has current work capacity and has returned to work for not less than 15 hours per week is entitled during the second entitlement period is to be at the lesser of the following rates--

(a) 95% of the worker's pre-injury average weekly earnings, less the worker's current weekly earnings,

(b) the maximum weekly compensation amount, less the worker's current weekly earnings.

(3) The weekly payment of compensation to which an injured worker who has current work capacity and has returned to work for less than 15 hours per week (or who has not returned to work) is entitled during the second entitlement period is to be at the lesser of the following rates--

(a) 80% of the worker's pre-injury average weekly earnings, less the worker's current weekly earnings,

(b) the maximum weekly compensation amount, less the worker's current weekly earnings."

1. I find on the evidence that from 5 June 2025 to the date of the applicant's revision right total hip replacement surgery on 15 October 2025, she had no current work capacity in accordance with s 37(1) of the 1987 Act. In this regard, the evidence is consistent:

(a) she says in her 10 October 2025 statement (see paragraph 25 above) that she struggles with walking, running, using stairs, standing for long periods of time, and sitting for long periods of time - she requires ongoing treatment, and she is in constant pain which affects her entire life - this description is certainly consistent with a finding of no current work capacity;

(b) she is supported by certificates of capacity from Dr Booth covering the relevant period - the certificates all certify as to her having no current work capacity - see paragraph 53 above;

(c) Dr McGrath's recording of her symptoms when he consulted with her on

26 June 2025 and on 4 September 2025 are consistent with her statement's description of those symptoms - the doctor notes that she required the assistance of a walking stick when he consulted with her on 4 September 2025;

(d) Dr Lwin also noted during a consultation with her on 24 June 2025 that she was still mobilising with the aid of a walking stick - see paragraph 56(f) above;

(e) Professor Ghabrial opines that she is currently unfit to return to work, when he examines her on 11 September 2025 - see paragraph 39 above, and

(f) when Dr Riley examines her on 20 May 2025:

(i) he notes that she is improving, but still suffering from pain especially after prolonged standing, walking or sitting - he notes her tolerance with each of these activities to be only 20 minutes - he also notes that she continues to use a walking stick - see paragraph 58(g) above, and

(ii) he opines that she is currently unfit for any work duties - see paragraph 65 above.

1. In relation to the period from the applicant's revision right total hip replacement surgery on 15 October 2025 to date, she has continued to be supported by certificates of capacity from Dr Booth, certifying her as having no current work capacity (see paragraph 53 above). There is no evidence before me to the contrary.
2. Professor Ghabrial (see paragraph 39 above) opines that her fitness for work should be re-assessed six months after the revision right total hip replacement surgery; that is, after

15 April 2026. 3. Further, the applicant's description of her current symptoms and restrictions (in her

2 December 2025 statement - see paragraph 28 above) is consistent with her currently having no current work capacity. 4. I therefore find that the applicant has had no current work capacity during the entire period from 5 June 2025 to date. 5. The parties have agreed that the applicant's unadjusted PIAWE (at 6 January 2025) was $2,889.85 - see paragraph 13(d) above. This PIAWE then needs adjusting as follows, in accordance with part 3 division 6A of the 1987 Act:

(a) from 1 April 2025 - $2,900;

(b) from 1 October 2025 - $2,940, and

(c) from 1 April 2026 - $3,000.

1. As a result of my findings regarding the applicant's capacity, she is entitled to 80% of her adjusted PIAWE in accordance with s 37(1) of the 1987 Act, being:

(a) $2,320 per week between 5 June 2025 and 30 September 2025;

(b) $2,352 per week between 1 October 2025 and 31 March 2026, and

(c) $2,400 per week from 1 April 2026.

1. I find that the applicant sustained an injury to her right hip on 6 January 2025, in accordance with ss 4 and 9A of the 1987 Act.
2. I find that the applicant sustained a consequential infection in her right hip, resulting from the injury sustained by her on 6 January 2025.
3. I find that the treatment expenses incurred by the applicant, to treat her infection and to undergo revision right total hip replacement surgery on 15 October 2025, are reasonably necessary expenses in accordance with s 60 of the 1987 Act, resulting from the injury sustained by her on 6 January 2025.
4. I find that the applicant has had no current work capacity from 5 June 2025 to date, resulting from the injury sustained by her on 6 January 2025.
5. There will be consequential awards for the applicant pursuant to ss 60 and 37(1) of the 1987 Act.