Zanardo & Rodriguez Sales & Services Pty Ltd v Tolevski
[2013] NSWCA 449
At a glance
Source factsCourt
Court of Appeal (NSW)
Decision date
2013-12-17
Before
Beazley P, Leeming JA, Keating P
Catchwords
- (2009) 239 CLR 27 Bindaree Beef Pty Ltd v Riley [2013] NSWCA 305 Carr v Western Australia [2007] HCA 47
- (2013) 87 ALJR 588 Construction Forestry Mining & Energy Union v Mammoet Australia Pty Ltd [2013] HCA 36
- (2013) 87 ALJR 1009 Enfield City Corporation v Development Assessment Commission [2000] HCA 5
- (2000) 199 CLR 135 Haroun v Rail Corporation New South Wales [2008] NSWCA 192
Source
Original judgment source is linked above.
Catchwords
Judgment (6 paragraphs)
Background 3The facts are uncontroversial. The applicant trades as "Canterbury BMW" and employed the respondent as a Car Detailer. One of his duties was washing cars on display. On 30 July 2007, Mr Tolevski fell while at work and injured his left leg and knee. His claim for workers compensation was accepted and there is no dispute that he was paid all compensation entitlements for the following four and half years. Notwithstanding two arthroscopies, he remains unwell. His solicitors, by letter dated 8 March 2012, requested approval for bilateral hip replacement surgery, as recommended by his orthopaedic surgeon, who stated: "Mr Tolevski is a 38 year old man who presents with a very difficult problem. He has advanced osteoarthritis of both hips. From a historical perspective it seems that this was precipitated by a fall which occurred at work approximately 5 years ago. He has since had multiple treatments including two arthroscopies of his left knee. His hips have continued to deteriorate and he is barely able to walk. He has also gained a great deal of weight in this time. Mr Tolevski requires bilateral total hip replacements." 4By letter dated 13 March 2012, that request was refused by Cambridge Integrated Services Australia Pty Ltd, as agent for the NSW WorkCover Scheme: "We dispute that you suffered an injury to either hip arising out of or during the course of your employment on 30 July 2007 or at all. We dispute that any arthritic condition in your hips is attributable to the injury to your left knee on 30 July 2007. We dispute that any treatment and/or investigations required in respect to your hips is in any way connected with the injury on 30 July 2007 or to your previous employment with the employer." 5A notice under s 74 of the 1998 Act was enclosed. That notice contained reasons elaborating the decision in the "plain language" then required by s 74(2B), in essence maintaining that there was no causal connection between the injury to Mr Tolevski's hips and the injury suffered on 30 July 2007. The reasons emphasised two matters. The first was that there was no mention of any injury to the hips in any of the documents relating to the injury, or in any of the (numerous) reports from medical practitioners between 2007 and November 2011. The second was directed to refuting any suggestion that Mr Tolevski's need for hip replacement was indirectly caused by the 2007 injury, because it had led to weight gain. The notice stated that it was not accepted that Mr Tolevski had gained any significant weight since 2007 (noting that he currently weighed 145 kilograms), and that in any event, on the basis that he said that he mobilised using two crutches, it followed that any additional weight that might have been put on since 30 July 2007 would have been borne by the crutches. The reasons included: "● In the circumstances as you have not been weight bearing in respect to either leg we are not satisfied that there is any evidence that any injury to your left knee and the subsequent symptoms in your left knee have in any way contributed to the development of bilateral hip arthritis. ● That you have not been weight bearing on either leg for approximately four years given your use of two crutches on a regular basis since the original injury on 30 July 2007. ● In the circumstances we do not accept that there is any evidence to suggest a nexus between the development of bilateral hip arthritis and the injury to your left knee." 6On 26 September 2012 the matter came before Arbitrator Wynyard for hearing. He found that Mr Tolevski had not discharged his onus of proving that he suffered from a consequential condition in his hips as a result of the original injury to his knee. 7Mr Tolevski appealed pursuant to s 352 of the 1998 Act to a Presidential Member (Judge Keating), who referred the parties to s 60(5) of the 1987 Act, which had been inserted by the Workers Compensation Legislation Amendment Act 2010 (2010 Act), with effect from 1 February 2011, to which the Arbitrator had not been taken. He also referred to the second reading speech, which identified the mischief to which it was directed: a lack of jurisdiction to determine whether proposed, but disputed, medical treatment was covered (New South Wales Legislative Assembly, Parliamentary Debates (Hansard), 23 June 2010 at 24,637): "[A] presidential decision has determined that the commission has jurisdiction to make determinations for medical or other treatment only where the expense has already been incurred. This means that in instances where there is a dispute between the scheme agent or insurer and a worker with regard to whether treatment is reasonably necessary, workers are unable to have their dispute heard at the commission unless they first pay for the treatment themselves. Many injured workers do not have the financial capacity to pay for major treatment and wait for reimbursement from the insurer. The amendment will ensure that the commission has the power to make a decision about whether treatment requested, but not yet received, is reasonably necessary, medically appropriate and in the best interests of the injured worker. This will be achieved by ensuring that an approved medical specialist gives an opinion with regard to the treatment, and the opinion of the approved medical specialist is taken into account in the decision." (emphasis added) 8The Presidential Member also referred to Inghams Enterprises Pty Ltd v Stanhope [2012] NSWWCCPD 32 which had held that the second sentence in s 60(5) was mandatory. He agreed with the discussion and conclusions in that decision. He relied upon the ordinary and grammatical sense of the words used, confirmed by the second reading speech. He concluded (at [51]-[52]): "Ultimately, the determination of whether treatment of Mr Tolevski's hips results from the injury to his knees, and is reasonably necessary will be a matter for the Arbitrator. Any opinion expressed by an AMS on referral under s 60(5), will be treated as evidence in the resolution of that dispute but will not be conclusive, as such an opinion is not one of the matters listed in s 326 of the 1998 Act that are conclusively presumed to be correct in proceedings before the Commission. For these reasons, whilst there remained in issue a dispute concerning whether the proposed treatment was reasonably necessary as a result of the injury on 30 July 2007, the decision by the Arbitrator to reject Mr Tolevski's application, without referring the dispute in accordance with s 60(5) for assessment by an AMS under Pt 7 of Chp 7 of the 1998 Act, was an error." 9The Presidential Member revoked the decision of the Arbitrator, remitted the matter to the Registrar for referral to an Approved Medical Specialist (AMS) in accordance with s 60(5), and made no order as to costs, because neither party had referred to s 60(5). 10The single ground of appeal relied on in this Court was that there was error in "holding that it was mandatory to refer to an AMS the dispute or disputes between the parties before determining causation."