** At the telephone conference of 18 March 2004 to which I refer below it was agreed that this date should be 6 August 2002, the date of the claim for compensation.
24 On 8 December 2003, the appellant's solicitors wrote to the Commission referring to the respondent's solicitor's letter and saying:
"We act for the respondent and refer to the letter sent to you by the worker's solicitors dated 7 November 2003.
The respondent disputes the allegation of disease and the deemed date of injury being 6 August 2003.
The issues in dispute are as follows:
1. Whether the injury was in the nature of a disease of gradual process and the applicant's employment with the respondent is employment to the nature of which the injury was due.
2. Whether the injury was in the nature of an aggravation, acceleration, exacerbation or deterioration of a disease and if so, whether the applicant's employment with the respondent was a substantial contributing factor to any aggravation etc of the disease.
3. The cause and extent of any permanent disability allegedly suffered by the applicant.
4. The extent to which any permanent disability is attributable to a previous injury or pre-existing condition or abnormality.
5. Whether the applicant is entitled to compensation under s 67 for pain and suffering and if so, the amount that is reasonably proportionate to the maximum payable in a most extreme case."
25 The next relevant event appears to have been the telephone conference between the Arbitrator, the parties' legal representatives and the respondent on 18 March 2004. Mr Hick represented the appellant and Mr Maatouk represented the respondent. The appellant's complaints to the Deputy President (which were rejected) included an assertion that in the course of this hearing the Arbitrator assumed the role of an advocate and acted outside the bounds of his role as a conciliator/arbitrator and had predetermined his position. The rejection of this complaint is the subject of the first two grounds of appeal and, accordingly, it is necessary to set out the relevant portions of the transcript of that hearing:
" [After introductory formal matters]
ARBITRATOR: Area Health Service, South Western Sydney Area Health Service. This is a teleconference I've asked to be recorded because there's sufficient information before me to make a decision on the material given, assisted by both parties who are at the teleconference. One is Peter Maatouk from Maatouks Law Firm. He's for the applicant. And the other is John Hick from Turks. Okay. Let's just finish what we're doing here and then we'll come back to the substantive argument. The CD can wind away there. The nature and conditions of the appellant's - of the applicant's employment with the respondent between - when did she start work?
MR MAATOUK: When did you start work with them?
APPLICANT: I've been with the hospital --
MR MAATOUK: Twenty-three years.
APPLICANT: Yes.
MR MAATOUK: I don't have an exact date. I know it was in 1980. She's been with them for 23 years.
ARBITRATOR: Oh, right.
[There was then an exchange concerning whether there was a gap in insurance]
ARBITRATOR: The applicant alleges that her duties with the respondent have aggravated, exacerbated, accelerated and/or deteriorated her injury, which is pleaded to be a disease. Right? No, we don't need anyone from 1980.
MR HICK: Sorry, what was the period, then?
ARBITRATOR: What I'm doing here is saying that the application is amended to allege the nature and conditions of the applicant's employment with the respondent between 1980 to date. The applicant alleges that her duties with the respondent have aggravated, exacerbated, accelerated and/or deteriorated her injury, which is pleaded to be a disease. Right?
MR HICK: Well, from 1980 to date involves a further period of insurance.
ARBITRATOR: But if it's a disease it doesn't at all because it's the --
MR MAATOUK: The last employer.
ARBITRATOR: The last employer pays.
MR HICK: That's right. But the employer --
ARBITRATOR: All right. Well, okay, so you are making an application for an adjournment so that an earlier employer can be - an earlier insurer can be joined. Is that right?
MR HICK: I'm trying to work out what the effect of the amendment is.
ARBITRATOR: The effect of the amendment is to regularise the pleadings so that everybody knows that the basis of the claim is the aggravation of a disease process under section 16.
MR HICK: Well, is it pleaded in the alternative to the injury as originally pleaded?
ARBITRATOR: Yeah. No, it's a - well --
MR HICK: An admission.
ARBITRATOR: I would have thought that the original - in view of the medical case, that the original claim wouldn't be pressed. It's a matter for you, Peter.
MR MAATOUK: Well, this whole thing, every time we speak it gets changed.
ARBITRATOR: Well, I mean, you can - it's your case. You can deal with it as you like.
MR MAATOUK: I think we should stay as a disease, but it should be noted that the injury is from 1993, the initial injury that aggravated.
ARBITRATOR: All right. So it's a disease or, in the alternative, a frank injury on that date. Is that right?
MR MAATOUK: That's right.
ARBITRATOR: Okay. Have you got that, John?
MR HICK: Yeah, I've got that.
ARBITRATOR: All right. Now, what do you want to say about that amendment?
MR HICK: I accept what you say, that in terms of the frank injury my client was on risk and the second allegation in the nature of a disease, my client would effectively be the party liable in that respect.
ARBITRATOR: Yep, yep. Now, that's the amendment. What's your attitude to it, bearing in mind your letter to us saying that you -
MR HICK: Our position is that on the evidence we'd dispute the allegation.
ARBITRATOR: Right. You are relying on a letter to us of the 8th - to the Commission of 8 December 2003, which says you dispute the allegation of disease and the deemed date of injury being 6 August 2003. Well, I think that's got to be 2002. I think we're agreed on that, are we not?
MR HICK: Yes.
ARBITRATOR: Yep. All right. Okay. And the matters you're putting in issue are whether it was in the nature of a disease, a gradual process, and the applicant's employment with the respondent is employment to the nature of which the injury was due. Your second point is whether the injury was in the nature of an aggravation, acceleration, exacerbation or deterioration of a disease, and, if so, whether the applicant's employment with the respondent was a substantial contributing factor to any aggravation, etcetera, of the disease. Then the third point is the cause and extent of any permanent disability allegedly suffered by the applicant. And then, fourthly, the extent to which any permanent disability is attributable to a previous injury or pre-existing condition or abnormality. And then, fifthly, whether the applicant is entitled to compensation under section 67.
MR HICK: Now, I think I should also perhaps add whether the applicant suffered any injury to her back and left leg arising out of or in the course of her employment.
ARBITRATOR: Right. Okay. Now, the next question is do you want to address this now or do you think this should properly be argued at a hearing?
MR HICK: Well, I'm happy to do it now.
ARBITRATOR: Okay. I think on the information before me we can do it now. You are happy to do that, Peter, are you?
MR MAATOUK: Yes, I am.
ARBITRATOR: All right. Well, John, would you like to make some submissions on it for the record?
[Mr Hick then made submissions that the Arbitrator could not be satisfied on the medical evidence that the opponent had suffered an injury in the nature of a disease within the meaning of 1987 Act, or that there had been any aggravation by reason of the opponent's employment, nor that the disease was one of gradual process attributable to employment. He put in issue the question whether the respondent had suffered any injury to her left leg and back arising out of or in the course of her employment and whether the symptoms which manifested from time to time indicated either injury, or injury in the nature of disease. He submitted that the case was one of "a frank injury [on 23 May 1993] to the right knee and nothing more", in respect of which the respondent had accepted liability]
ARBITRATOR: I'm just looking at your - yeah. All right. What you're saying is that the evidence is just not there to substantiate a disease allegation.
MR HICK: There's certainly no disease allegation, and particularly no relationship to the employment.
ARBITRATOR: All right. Well, Peter, I don't need to hear from you on this. I think I've indicated from the outset that I've got a certain view, and I'm grateful to you, John, for the help you've given in your submissions, but I'm still of the view that there is sufficient evidence, and let me just recap a bit for the sake of the record.
When this matter came before me, it was pleaded as a frank injury in 1993, but the medical evidence supplied from both sides of the record seemed to indicate that there had been ongoing problems of a disease nature. That evidence comes from Dr Rivett's report of 7 June 2002 for the applicant. He takes a history that she slipped on a kitchen floor in 1993, felt a ripping sensation, was off work for seven weeks. She resumed working four hours a day and worked a normal eight hours but continued to have pain intermittently, especially on stairs or prolonged walking. He then gives a number of different dates of further problems.
On 15 July 1988, the pain increased for no apparent reason. She went to an orthopaedic surgery and she had an arthroscopy at that stage, and there were loose bodies removed from the right knee and patellar surfaces. She was off for about six weeks then. Then on 20 July 1999 the pains in the right knee were aggravated by considerable walking when she was moved to a larger hospital. She was off work then for three months, and she started to develop some left sciatic pain as a result of this increased activity, says Dr Rivett, but had no lumbar pain at that stage. She thought favouring the right leg threw strain on the left side and on to her back.
On 13 December 2001 she walked up two flights of stairs and down again and the right knee swelled. She had treatment for that, and it settled down. And then again on 23 March 2002 when at home she was walking in a room when the right leg clunked and she fell on her knees.
The present symptoms: the right knee feels tight. There's pain extending below the patella. She's got pains around the left knee and she's developed some occasional lumbar aches. She's got limitations. She can walk for about 15 minutes but stand for only about five. She's got a lifting tolerance of 10 kilograms but she can't squat or kneel. That's the history given to the medico-legal specialist.
And Dr Hoe for the respondent takes a similar history of a problem in 1993. He takes a history in his report of 12 September 2002 that she said that ever since then - that is 23 September '93 - the right knee has never been quite right. It would throb and ache occasionally and at other times she could walk long distances without any problems. Being on her feet for extended periods of time would also cause problems. He details the further problems in July '98 and July '99.
Dr Perla, again for the respondent, takes a similar history, although he doesn't note the continuing problems she had between '93 and '98. Just dealing with the diagnosis, Dr Perla says that ongoing discomfort is related to a pre-existing degenerative osteoarthritic condition, and he says that employment with Camden Hospital is no longer a cause of any condition involving her knees. He raises a question that one of the incidences [sic, incidents] happened at home. His view is that the work had no relationship or was certainly not a substantial contributing factor to her condition.
Dr Hoe's view, again, was moderate degenerative changes in the right knee, mild degenerative changes in the left knee, mild degenerative changes in the lumbosacral spine. He, too, says that the current condition is not attributable to the incident in '93 but there's a flare-up of a pre-existing condition.
As opposed to that, Dr Rivett says that the applicant has got chondromalacia patella bilaterally and there are early osteoarthritic changes. There is marked microlateral ligament strain on the right and mild on the left. And he says also, number two, there is lumbar ligamentous strain and sacroiliac joint strain, possibly some right-sided sciatic nerve root irritation, and he says he would need to have an X-ray and possibly a CT scan to further the diagnosis. He says that the findings are consistent with the history given and in general all the problems are work related. There could possibly be some contribution from her overweight condition, including arthritic changes.
So, looking at those problems and - perhaps I should just mention Dr Hoe's last report. Dr Hoe says in support of the letter from the solicitors for the respondent dated 8 December disputing disease - he says that in his report of 25 November 2003, number three, that she did not have any injury or incident she could recall that caused onset of the left knee pain or low back pain or sciatic pain. There was a definite injury to the right knee in 1993. However, it took five years until 1998 when she experienced significant symptoms to seek orthopaedic opinion. This delay in time suggests that the original incident was not the only factor and that degenerative changes over time due to obesity and age were also significant factors in the cause of her arthritis in the right knee. The arthritis is almost symmetrical, i.e. present in both left and right knees, with no history of injury in the left knee. This also suggests that her problems in the knees are due to constitution, obesity and age rather than any work-related injury. It is also noted her job is essentially a sedentary one in the role of a supervisor. Therefore it is unlikely to be a substantial contributing factor to her current condition.
The problem with that, of course, is that the evidence, or the history that Dr Hoe took in his earlier report was that she did continue to have symptoms and, indeed, that history was taken by Dr Rivett, that she continued to have symptoms following 1993.
I prefer the evidence of Dr Rivett. I think the nature of the disease, which is osteoarthritis and the condition of chondromalacia patella is such that her duties in the workplace, even if they are mainly of a sedentary nature, would be sufficient to cause her injury and, therefore, I am satisfied that she suffers from an aggravation of a disease process. If I'm wrong in that and she has suffered a frank injury in 1993 which has never recovered and, as a result of her disease has aggravated to the degree that she has got at the moment, which is a question for the AMS. I am, however, satisfied that the condition in both her legs and her back is work related and is a result of a disease process, as advanced by Dr Rivett in his opinion.
Therefore, I find that the deemed date of injury is 6 August 2002. Now, having said that, we've now got to send it off to an AMS. Do we have any preference for an orthopaedic surgeon?
MR MAATOUK: Not really.
ARBITRATOR: So Commission to decide?
MR MAATOUK: Yes, please.
ARBITRATOR: Is that John or Peter talking?
MR MAATOUK: It's Peter.
ARBITRATOR: Right. John, are you happy with that?
MR HICK: Yes.
ARBITRATOR: And it's in relation to both legs and the back. That's the limit of the application, is it?
MR MAATOUK: Yes.
ARBITRATOR: And the Commission will automatically decide what is pre-existing or whether there's constitutional problems that reduce the amount of whole person impairment, anyway. There's no more material to come in. Is that correct?
MR MAATOUK: That's right.
…
ARBITRATOR: Yeah. All right. Okay. I think that's everything. So I'll refer it off to an AMS and the matter will eventually come back.
MR HICK: Okay.
ARBITRATOR: Anything else?
MR MAATOUK: No, that's it.
MR HICK: Not from me.
ARBITRATOR: Okay. Thank you, gentlemen." [emphasis added]
26 On 22 March 2004, the Arbitrator issued a document entitled "Statement of reasons - ex tempore orders" which stated:
"In this matter a telephone conference was held on 18 March 2004 following an earlier teleconference on 29 October 2003 in which leave was given to the Applicant to amend its [sic, her] pleadings to allege a disease process. The respondent did not agree that the applicant suffered from a disease and submissions were made by Mr Hick who appeared from Messrs Turks Legal for the respondent…
To ensure the parties received a timely determination of their dispute the reasons for the orders set out below were given orally at the telephone conference. A sound recording of the reasons given is available to the parties.
The orders made are as follows:
1. The Applicant suffered an injury which was caused by the aggravation, exacerbation, acceleration and/or deterioration of a disease - namely chondromalacia patellae and osteoarthritis. She also suffers from degenerative changes in the right knee, left knee and lumbosacral spine.
2. The deemed date of injury therefore is the date of the claim, which is agreed to be 6 August 2002.
3. The matter is to be referred to an Approved Medical Specialist in terms of the attached referral."
27 The appeal papers did not contain a copy of the referral.