Damages - non-economic loss
66The primary judge assessed damages for non-economic loss at $171,500 based on 33 per cent of a most extreme case. Primo and the Trust say that this was outside the bounds of a sound discretionary judgment, bearing in mind the apparently trivial nature of the plaintiff's injury as recorded at the time. They also submit that the conditions from which the plaintiff was found to suffer in the period after the accident were not attributable to the workplace accident and that the judge had failed to take proper account of unrelated causes of impairment.
67In support of the contention that the injury was, at the time, recorded as trivial, Primo and the Trust refer to the accident report form completed at the time which referred to "bruising". The plaintiff was absent from work for only two days and was then pronounced by her general practitioner, Dr Ly, to be fit for work, although on light duties in the first instance. The plaintiff continued to work full time after her return and did not make a workers' compensation claim. The plaintiff had a chest x-ray on 17 August 2006 (sixteen days after the accident). It was normal.
68The plaintiff next sought medical attention on 4 October 2006, more than two months after the accident. At that point, she had an X-ray of her ankle and foot. More than four months later, on 22 February 2007, the plaintiff was referred by Dr Ly to Dr Rosario who considered the symptoms to be suggestive of tendon sheath inflammation. Dr Rosario recommended rest, anti-inflammatories and ultrasound. An ultrasound of the ankle was performed on 27 March 2007 and MRI of the ankle and knee were carried out in July 2007. Injury to both was confirmed. Dr Rosario was of the opinion, however, that the plaintiff should be able to continue working as long as she avoided kneeling, squatting and climbing. In December 2007 and January 2008, the plaintiff attended physiotherapy for her knees and ankles.
69In February 2008 - some eighteen months after the accident - the plaintiff sought medical treatment for her back and underwent an MRI on a referral from Dr Rosario. This disclosed a degenerative disc disease and Tarlov cysts in the sacral spine. In about July 2008, the plaintiff was referred by Dr Ly to Liverpool Hospital for pain management. The outcome is not made clear by the evidence. A bone scan on 3 August 2009 showed mild arthritis of the spine, shoulders and hip joints. In October 2009, an MRI revealed posterior disc bulging in the spine.
70The foregoing appear to be the only occasions of investigation and treatment outside appointments arranged for specifically medico-legal purposes. The judge referred in detail to the various investigations undertaken by medical practitioners retained for the purposes of the proceedings. These were Dr Stephenson a consultant orthopaedic surgeon, Dr Matalani a consultant occupational physician, Ms Grinter a consultant occupational therapist and Dr Smith a consultant orthopaedic surgeon.
71The primary judge expressed surprise that there was no comprehensive report from Dr Rosario, given the relatively long period over which the plaintiff had obtained treatment from that practitioner. It may also be noted that none of the other practitioners who had actually seen and treated the plaintiff in the period after the accident was called as a witness. The judge had before him only correspondence and contemporary records involving those practitioners.
72The primary judge identified a conflict in the medical evidence concerning the nature and extent of the plaintiff's injuries from the accident and noted that he was called upon to determine the conflict without oral evidence from the several medical practitioners. He set about doing so by reference to the documentary evidence before him.
73The conflict was seen as one between Dr Smith on one side and Dr Ly, Dr Stephenson and Dr Matalani on the other. Dr Smith, who saw the plaintiff in May 2010, was of the opinion that there was no real evidence of significant trauma or of the claimed injuries to back, knees, ankles, neck and shoulders. Dr Ly issued certificates from time to time supporting the conclusion that the plaintiff suffered a crushing injury to her back and chest when struck by the trolley. Dr Stephenson was of the opinion that the plaintiff had injured her spine in the accident, while Dr Matalani accepted that the accident had caused soft tissue injuries involving the neck and back producing left shoulder symptoms related to the neck injury and leg weakness related to the back condition. The judge regarded the evidence of Dr Rosario as not contributory to a resolution of the controversy he had identified.
74The judge expressed a preference for the evidence of Dr Ly, Dr Stephenson and Dr Matalani over that of Dr Smith. He gave six reasons for doing so. First, Dr Smith had apparently approached the assessment without giving much weight to the plaintiff's own account of the accident. Second, Dr Smith, unlike the others, had not had the advantage of re-examining the plaintiff over time. Third, to the extent that Dr Smith proceeded on the basis that the plaintiff was manufacturing symptoms, he was relying on something not put to the plaintiff. Fourth, Dr Smith resorted to an "unexplained subjective expression of opinion" ("no significant post-traumatic lesion"). Fifth, Dr Smith appeared to discount entirely the historical evidence of the plaintiff. Sixth, Dr Smith did not see the contemporaneous injury report.
75It is instructive to refer to that report. It shows quite clearly that the area of injury was in the upper left chest below the collarbone and correspondingly on an area of the back slightly below the shoulder. The moving trolley came into contact with the plaintiff's back and caused her chest to be "squashed" against the pallet jack handle in front. Areas affected are listed as "chest", "shoulder" and "back".
76Having resolved the conflict in the evidence in the way I have described, the judge concluded that injuries to the chest, back, neck and spine were the product of the accident, but that knee and ankle injuries were not.
77Primo and the Trust complain, with justification, that the conclusions based on medico-legal reports by specialists specially retained a considerable time after the event should have been treated with much greater caution, particularly since their foundation was, in large measure, statements made by the plaintiff to the examining doctors. There was a stark paucity of evidence from doctors who had seen the plaintiff in the period immediately after the event or at later times for the purposes of treatment as distinct from medico-legal assessment.
78The contemporaneous evidence goes to examinations and treatment by Dr Ly and Dr Rosario, neither of whom gave oral evidence. Dr Ly's assessment immediately after the accident was that the plaintiff was fit to go back to work after two days - as she indeed did. Dr Ly ordered a chest x-ray, something commensurate with the area of impact. As I have said, it was normal. And significantly, Dr Ly completed WorkCover medical certificates on 9, 10, 19 and 28 August 2006 in which he recorded a diagnosis expressed variously as "Soft tissue injury", "Soft tissue chest and back pain" and "Back and chest pain". Each certificate stated that the plaintiff was fit for suitable duties, but with qualifications in the first three (but not the fourth) about heavy lifting and the like.
79Thereafter in October 2006 and February 2007, Dr Ly ordered an x-ray of the ankle and foot and referred the plaintiff to Dr Rosario for "Chronic right ankle pain, burning sensation on prolonged standing". Given the nature of the accident, problems with the ankle and foot could not have been consequences; and the judge so found. The March 2007 ultrasound related to the ankle and knee, as did the July 2007 MRI and the physiotherapy of December 2007 and January 2008.
80It was not until February 2008, some eighteen months after the accident, that the plaintiff sought medical assistance in relation to her back. It was the MRI carried out at that time that revealed degenerative disc disease. The bone scan of August 2009 disclosed mild arthritis in the spine, shoulders and hip joints. Dr Matalani made a report dated November 2009 in which he expressed the opinion that the plaintiff suffered a soft tissue and chronic musculoligamentous strain of the neck and back representing zero whole person impairment in relation to the neck and 7 per cent in relation to the back.
81Primo and the Trust submit that the judge failed to give sufficient weight to the contemporaneous evidence and that, had he done so, the finding would have been that the only injury to areas that could have been affected by the impact on the upper chest and upper back (that is, injury to the chest, back and neck) manifested itself a year and a half after the event and was, in any event, of a degenerative nature consistent with gradual onset, so that the plaintiff did not establish necessary causation.
82That submission should be accepted. In the absence of contemporaneous evidence from treating doctors indicating a link between the ultimate chest and shoulder problems and the workplace accident (and with the tests of February 2008 and October 2009 disclosing conditions not limited by any medical evidence to the accident), there was, at best, an insubstantial and tenuous theoretical basis for the necessary finding of causation. That basis was, in my opinion, insufficient to discharge the burden that lay upon the plaintiff to show that the injuries she claimed to have suffered through the accident in fact had their source in that event.
83There can be no doubt that the plaintiff did sustain some pain and suffering as a result of the accident. But on the evidence before the judge, it came from soft tissue injury and was minor, necessitating only two days absence from work and restriction to light duties for a short time after return to work. In those circumstances, the extent of the pain and suffering attributable to the workplace accident must be accepted as below the level of 15 per cent of a most extreme case made relevant by s 16 of the Civil Liability Act. It may readily be accepted that Dr Matalani's assessment of 7 per cent whole person impairment would indicate something very far short indeed of a most extreme case. That being so, the plaintiff should be regarded as having failed to prove an element essential to recovery of damages for non-economic loss. The award of damages under that heading should be set aside.