Bishop v Camden District Hospital - [2013] NSWWCCPD 40

WORKERS COMPENSATION COMMISSION
DETERMINATION OF APPEAL AGAINST A DECISION OF THE COMMISSION CONSTITUTED BY AN ARBITRATOR
Status: Appeal dismissed by Court of Appeal – State of New South Wales v Bishop [2014] NSWCA 354
CITATION:	Bishop v Camden District Hospital [2013] NSWWCCPD 40
APPELLANT:	Karen Bishop
RESPONDENT:	Camden District Hospital
INSURER:	Employers Mutual Limited
FILE NUMBER:	A1-7780/12
ARBITRATOR:	Mr J Phillips SC
DATE OF ARBITRATOR’S DECISION:	19 March 2013
DATE OF APPEAL DECISION:	25 July 2013
SUBJECT MATTER OF DECISION:	Injury; causation; consequential loss; duty to state sufficient reasons for decision; factual error
PRESIDENTIAL MEMBER:	Deputy President Kevin O'Grady
HEARING:	On the papers
REPRESENTATION:	Appellant:	Deborah Ens Lawyers
Respondent:	Thompson Eslick Solicitors
ORDERS MADE ON APPEAL:	1. Time to make this appeal is extended to 19 April 2013 pursuant to Pt 16 r 16.2(12) of the Workers Compensation Commission Rules 2011. 2. Paragraphs 2, 4, and 5 of the Certificate of Determination are confirmed. 3. Paragraph 1 is revoked and in its place the following order is made: “1. The matter is remitted to the Registrar for referral to an Approved Medical Specialist for assessment of any additional whole person impairment of the applicant’s lumbar spine as a result of injury received on 6 May 2004, and of any whole person impairment with respect to her left lower extremity following a fall on 25 June 2011, which fall and any consequential loss is found to be causally related to that injury of 6 May 2004.” 4. Paragraph 3 is revoked and in its place the following order is made: “3. The Respondent is to pay medical and associated expenses reasonably incurred in respect of treatment of her left lower extremity in accordance with former s 60 of the Workers Compensation Act 1987”. 5. The respondent is to pay Ms Bishop’s costs of the appeal.

BACKGROUND

This appeal concerns a challenge to an Arbitrator’s finding that there was no proven causal connection between a worker’s compensable back injury received in 2004 and a fall, the consequence of which was a significant leg injury, which occurred in June 2011 at the worker’s home.
Ms Karen Bishop commenced employment with Camden District Hospital (the employer) as a cleaner in 1994. It is not disputed that Ms Bishop received an injury to her lower back as a result of her arduous duties on 6 May 2004. She consulted her general practitioner Dr Mechreky who arranged a lumbar spine CT scan and prescribed anti-inflammatory medication.
Ms Bishop, who at that time was employed full time, was absent from work for a short period, following which she returned to selected duties. Thereafter she returned to normal duties but continued to experience disabling pain. From time to time she worked reduced hours or was absent from work by reason of her continuing symptoms.
Ms Bishop states in evidence that, on 25 June 2011, she was walking on a concrete path to the clothes line at her home when her left leg “gave way” causing her to fall. She injured her left foot and ankle. She has not worked since that fall by reason of ongoing incapacity.
It seems that weekly compensation was paid by the employer’s insurer until 5 December 2011. The evidence does not reveal the circumstances of the cessation of those payments. However, it is clear that the insurer had served a notice pursuant to s 54 of the Workers Compensation Act 1987 (the 1987 Act) at some time and that Ms Bishop had sought reconsideration of an apparent decision to discontinue weekly payments. At about the same time the solicitors acting for Ms Bishop made a claim by letter dated 19 December 2011 in respect of “13 per cent whole person impairment” being the sum of $10,750 (the difference between $17,000 and $6,250 previously paid in respect of five per cent whole person impairment) together with the sum of $20,000 pursuant to s 67 of the 1987 Act. The lump sum claims were founded not only upon the alleged consequences of the lumbar spine injury, but also those of injury to the lower extremity (left ankle) as assessed by Dr Peter Conrad, specialist surgeon.
The claim in respect of permanent impairment was declined and notice of that decision rejecting the claim was given to Ms Bishop’s solicitors in correspondence dated 14 February 2012. That correspondence was the subject of amendment as found in a subsequent letter, also forwarded on 14 February 2012, which purported to be a notice issued pursuant to s 74 of the Workplace Injury Management and Workers Compensation Act 1998 (the 1998 Act). That second letter included a denial in respect of liability for medical expenses and weekly payments in relation to injury received on 6 May 2004. It was also stated in that notice that liability for medical expenses and weekly benefits in relation to “the recurrence sustained by you on 25 June 2011 in respect to the injury to the ankle” was also declined.
An Application to Resolve a Dispute was filed with the Commission by Ms Bishop in July 2012. The claim, following amendment, sought orders with respect to payment of medical, hospital and rehabilitation expenses and lump sums as earlier claimed. The matter was listed for conciliation/arbitration before Arbitrator Jeffrey Phillips SC on 20 February 2013. The matter proceeded to arbitration and the Arbitrator reserved his decision.
A Certificate of Determination was issued by the Arbitrator on 19 March 2013 in the following terms:
“The Commission determines:
1.       I refer to the Registrar to have an Approved Medical Specialist assess additional whole person impairment of the applicant’s lumbar spine as a result of the injury of 6 May 2004.
2.       The Approved Medical Specialist is to have regard to exhibits tendered in this case and to take into account any payments made for earlier assessments in relation to the said injury.
3.       In relation to the claim for a consequential injury to the applicant’s left lower extremity (foot and ankle) for the injury of 6 May 2004 there shall be an award for the respondent.
4.       The respondent will pay the applicant’s costs as agreed or assessed.
5.       To those costs on the grounds of complexity to both parties I provide an uplift of 20 per cent.
A brief statement is attached to this determination setting out the Commission’s reasons for the determination.”

ISSUES IN DISPUTE

The grounds relied upon by Ms Bishop suggest error on the part of the Arbitrator in the following respects:
(a) in determining that there was no “causal link” between the injury received on 6 May 2004 and “the consequential left leg injury” received on 25 June 2011, and
(b) failing to give “proper reasons” for his determination of the dispute.

THRESHOLD MATTERS

There is no dispute that the threshold requirements as to quantum found in s 352(3) of the 1998 Act have been met. However the requirement as to time for making an appeal, that is within 28 days of the making of the decision appealed against as provided by s 352(4), has not been met. The appeal documents were registered with the Commission one day late, that is 29 days after the making of the decision.
Submissions have been made by Ms Bishop seeking an order extending the time for making this appeal. Discretion to so order is granted to the Commission by sub-r 12 of Pt 16.2 of the Workers Compensation Commission Rules 2011 (the 2011 Rules) which provides:
“(12) The Commission constituted by a Presidential member may, if a party satisfies the Presidential member, in exceptional circumstances, that to lose the right to seek leave to appeal would work demonstrable and substantial injustice, by order extend the time for making of an appeal.”
The explanation for non-compliance with the rule is to be found in submissions filed belatedly by Ms Bishop’s solicitor. Shortly stated, the relevant circumstances were that counsel’s advice and draft submissions had been received by the solicitor by 11 April 2013 (mistakenly noted as 11 April 2011) and the relevant Application was engrossed on that day. The solicitor, whose practice is outside the Sydney central business district, does not “use the DX as it is not readily available to [her]”. It was intended by the solicitor to register the appeal application on 12 April 2013 at which time the solicitor was in the city of Sydney on other business. On that day counsel communicated a need to amend the submissions as drafted. The document was not registered on that day as was intended.
The amended document was prepared on 15 April 2013 (wrongly stated in submissions to be 2012) following which the relevant time limit was wrongly calculated by the solicitor. A decision was taken to send the document by post rather than to send it by fax transmission. The document was not received by the Commission until 19 April 2013, one day outside the limitation period. The solicitor, in submissions, accepts “full responsibility” for the late filing.
There is nothing put by way of explanation for delay that could be characterised as “exceptional circumstances” as that term is understood: see discussion by Snell ADP in Rockhard Products Pty Ltd v Economidis [2009] NSWWCCPD 159 (Economidis) at [31] and [32] where the decision in Yacoub v Pilkington (Australia) Ltd [2007] NSWCA 290 is considered. However, that is not to say that such conclusion is fatal to Ms Bishop’s application. As was decided in Bryce v Department of Corrective Services (NSW) [2009] NSWCA 188 (again the subject of discussion in Economidis) by Allsop P (with whom Beazley JA, as her Honour then was, and Giles JA agreed):
“… In my view the phrase ‘in exceptional circumstances’ finding its place in the middle of the rule is to be dealt with as a matter to be considered by the Presidential member as a matter within jurisdiction as opposed to a precondition to the operation of jurisdiction” (at [8]).
No submissions opposing Ms Bishop’s application have been put on behalf of the employer. It may thus be safely inferred that a grant of an extension would not give rise to relevant prejudice. It must also be noted that Ms Bishop’s delay was in respect of one day only.
The matters raised in the appeal by Ms Bishop, as may be seen from my reasons and conclusion appearing below, have force and thus the interests of justice require, in my view, that, notwithstanding the absence of proof of exceptional circumstances, an extension of time to 19 April 2013 for making the appeal should be granted. I so order.

THE ARBITRAL PROCEEDINGS

Proceedings before the Arbitrator were recorded, a transcript (T) has been produced and a copy has been made available to each party.
It was noted by the Arbitrator that the employer had admitted the occurrence of the lumbar spine injury as alleged. The only matter in dispute, it was further noted, was whether the injury to Ms Bishop’s left leg was “compensable”.

The evidence

The documentary material admitted into evidence was noted by the Arbitrator at [7] of his Statement of Reasons (Reasons).
Ms Bishop, in a written statement made 19 June 2012, described the nature of her work and the circumstances of her injury in 2004. She stated that upon return to work she had periods when she was unfit because of her back and that from time to time she had been certified fit for light duties or reduced hours. She had attended Dr Mechreky “regularly”.
Ms Bishop further stated that her back pain had increased since that injury and that her left leg would, from time to time, “collapse”. She had settled a lump sum claim in May 2007 “on the basis of five per cent whole person impairment”. Following her experience of left leg pain her general practitioner referred her to Dr Noel Dan, neurosurgeon, in 2007. Nerve conduction studies were arranged.
It was further stated that problems with the “left leg giving way had increased” and that Dr Mechreky arranged for an updated CT scan of the lumbar spine in June 2010. A further scan was arranged following a worsening of symptoms in the back and left leg in March 2011.
Ms Bishop continued working “on and off doing light restricted cleaning work up to 24 hours per week”. On 25 June 2011 her left leg gave way at home causing her to fall. She injured her left foot and ankle. She has not returned to work since that date. She had been referred to Dr John Harrison, orthopaedic surgeon, whom she saw in October 2011. Nerve conduction tests of both legs and a lumbar spine MRI were arranged. Ms Bishop has not returned to Dr Harrison “because liability is now declined”.
When cross-examined at the hearing before the Arbitrator, Ms Bishop confirmed that her left leg would, from time to time, collapse before her fall on 25 June 2011. She was not sure as to how many occasions such collapse or “giving way” had occurred. She stated that she had sometimes on those occasions fallen to the ground and on other occasions she would “grab” something for support to prevent a fall. When questioned as to whether Ms Bishop connected these events of leg collapse with her back pain she replied “yeah, because at one stage, when I seen [sic] Professor Dan, I told him about my left leg giving way and he sent me for a nerve test on my left leg”.
Ms Bishop agreed that Dr Mechreky had been her general practitioner since a date prior to the back injury in 2004 to the present time. It was suggested in cross-examination that Ms Bishop did not report to Dr Mechreky that the left leg had given away. Ms Bishop stated that she “would have”. It was agreed by Ms Bishop that she had reported to Dr Mechreky that she had some pain in both of her buttocks and that she had felt pain radiating from her back. She also reported to Dr Mechreky that she had some feelings of pins and needles from time to time. It was again put to Ms Bishop that she had “never once told [Dr Mechreky] that [her] leg collapsed”. Ms Bishop’s reply to this was “I would of (sic)”. It was further put to Ms Bishop that she had not reported to Dr Dan in 2007 that her leg had, from time to time, collapsed. Ms Bishop’s response was “I don’t know if it had collapsed by the first time I’d seen Dr Dan”.
When questioned concerning her attendance upon Dr Peter Giblin, Ms Bishop stated that she “couldn’t speak to him”. It was further stated that Dr Giblin “didn’t really want to hear what was wrong with me. I was in there for like two minutes and out”. Ms Bishop further stated that she informed her general practitioner that she did not want to go back to see Dr Giblin because she felt “really uncomfortable” and that she would rather go back and see Professor Dan.
Counsel questioned Ms Bishop concerning the circumstances of her fall in June 2011. Ms Bishop agreed that she had reported to Dr Silva, who had examined her on behalf of the employer following that incident, that “on the way to the clothes line, [Ms Bishop] rolled [her] ankle”. Ms Bishop also agreed with counsel that she had experienced problems with her knees for some time prior to that fall. Ms Bishop agreed that, before that fall in 2011, she had reported to Dr Mechreky that she had experienced pain in both her knees and that the left knee was “worse” than the right. Ms Bishop stated in evidence that she had reported the pain to Dr Mechreky in May 2011 and on occasions earlier. When questioned as to the sequence of events, the question being “did your leg give way first or did you roll your ankle first?”, Ms Bishop replied: “no, the leg give (sic) way and I just went down. As it went, I just sort of went down with it.”
Counsel expressly put to Ms Bishop that the leg had not given way “prior to this day, the 25^th June 2011”. Ms Bishop replied “It has. It has given way before then”. In response to further questioning Ms Bishop asserted that she “would have told [Dr Mechreky] and a lot of the times he’s put down there back pain and left leg, left leg and even on all the WorkCover ones that go into WorkCover, it’s always the back, lower back and my left leg. That went in week, after month, after month, it’s always the lower back and the left leg.”
Ms Bishop relied upon the evidence of her treating doctors, Dr Dan, Dr Giblin and Dr Harrison. Reports from each of those practitioners are before the Commission. That evidence, where relevant, is discussed below. Reliance was also placed upon the evidence of Dr Conrad who had been qualified to provide a report for the purposes of the litigation. Dr Conrad expressed the opinion that Ms Bishop suffered a whole person impairment of seven per cent in respect of her lumbar spine and six per cent in respect of her lower extremity (left ankle). Dr Conrad’s views as to the relevance of the 2004 injury to the occurrence of injury in 2011 are discussed below.
A number of radiological studies relevant to both the lumbar spine and the left ankle are before the Commission. Those reports may be summarised as follows:
(a)     CT scan lumbosacral spine
17 May 2004
“At L4/5 there is a minor broad based disc bulging but no evidence of nerve root compression or foraminal narrowing. At L5/S1, there appears to be a tiny central disc protrusion but there is no evidence of nerve root contact. The canal remains widely patent.”
(b)     Lumbar MRI scan
30 August 2004
“There is early disc dehydration/desiccation at the 2 lower lumbar levels. There is minimal central bulging of the L5/S1 disc but without gross protrusion or neural encroachment .”
(c)     CT lumbar spine
27 September 2007
“At the L3/4 level, there is some mild bulging of the foraminal aspect of the disc, without overt neural compression. There is no significant central canal stenosis or significant facet joint disease.
At the L4/5 level, there is minor broad based posterior disc bulging, without significant canal stenosis or features of neural compression. There is no significant facet joint disease.
At the L5/S1 level, there is mild broad based posterior disc bulging without significant impression upon the sequel sac. There is foraminal narrowing bilaterally related to the disc bulging, with some effacement of the perineural fat, indicating potential impingement of the exiting portions of both L5 nerve roots. There is no significant facet joint disease.”
(d)     CT lumbar spine
18 June 2010
“Findings: No paraspinal masses noted. No destructive bony lesions identified. No pars defects evident. There is loss of the normal lumbar lordosis. This is most likely due to muscle spasm. Anterior osteophytosis is demonstrated. There is a tilt of the lumbar spine towards the right.
At the L1-2 level, no significant disc bulging, herniation or exit foraminal stenosis identified.
At the L2-3 level, no significant disc bulging, herniation or exit foraminal stenosis identified. Minor facet joint degenerative change identified.
At the L3-4 level, no significant disc bulging, herniation or exit foraminal stenosis identified.
At the L4-5 level, a broadbased disc bulge is identified. There is a distortion of the anterior aspect of the thecal sac. No exit foraminal stenosis identified. Facet joints define normally.
At the L5/S1 level, there is vacuum phenomenon within the L5/S1 disc. Anterior and lateral osteophytosis is demonstrated. There is a broadbased disc bulge with bilateral paracentral components. There is disc encroachment on the vertebral exit foramina bilaterally, more marked on the left.
Comment: Impingement on the L5 nerve roots and the exit foramina at the L5/S1 level bilaterally identified. Facet joint degenerative change identified. There is a minor disc bulge at L4/5. Other findings as above.”
(e)     CT lumbar spine
2 March 2011
“At the L2/3 level, no significant abnormality identified.
At the L3/4 level, there is some minor bulging of the left paracentral/foraminal aspect of the disc, causing some minor foraminal narrowing but without features of neural compression. There is no significant central canal stenosis. There is some minor bony hypertrophy of the facet joints.
At the L4/5 level, there is mild broad based posterior disc bulging, eccentric to the left side where there is some narrowing of the lateral recess and potential impingement of the left L5 nerve root. There is some minor bony hypertrophy of the facet joints.
At the L5/S1 level, the disc is slightly reduced in height and contains gas, in keeping with degenerative changes. There is mild broad based posterior disc bulging without significant central canal stenosis. The bulging extends into the foraminal area on the left side where there is quite marked foraminal narrowing, with effacement and likely impingement of the exiting left L5 nerve root. There is some minor bony hypertrophy of the facet joints.”

A number of studies of Ms Bishop’s left foot and ankle are in evidence. A MRI of the left foot conducted on 7 September 2011 was summarised by Professor Suzanne Anderson who expressed her conclusion as follows:
“Posterior malleolus undisplaced fracture. Marrow signal intensity suggests subacute lesion. Soft tissue altered signal intensity is consistent with recent re-injury suspected. Ligamentis features tear of anterior tibiofibular ligaments and partial of anterior talofibular ligament noted”.
The clinical notes concerning Ms Bishop’s attendance upon the practice of Dr Mechreky between 12 August 2000 and 3 December 2012, which had been produced by that practitioner, have been tendered in evidence. Those records comprise approximately 300 pages of handwritten foolscap sheets. Also included are copies of WorkCover NSW medical certificates issued by Dr Mechreky between 27 July 2010 and 4 September 2012. Those notes also included a copy of a report from Dr Con Kafataris, injury management consultant, addressed to the employer’s insurer. The contents of these various documents is considered, where relevant, in the course of discussion below.
The employer had tendered a report from Dr Thomas A Silva, consultant orthopaedic surgeon, dated 30 September 2011. The content of that report is discussed in some detail in the course of discussion hereafter; however, it is to be noted that Dr Silva expressed the opinion that he was not persuaded that Ms Bishop had “any significant lumbar spine disability that had contributed directly or indirectly for (sic) her rolling of the left ankle”.

Submissions before the Arbitrator

Counsel for the employer submitted that the task before the Arbitrator was to determine whether, on the probabilities, it had been established that injury to the back in 2004 had caused muscular weakness in Ms Bishop’s left leg. The content of the reports of Dr Giblin and Dr Dan were addressed and it was noted that there was no history recorded by those practitioners of the left leg “giving way” prior to the ankle injury in 2011. It was also emphasised that there was no recorded history of weakness in the left leg or of any fall, nor of a collapsing of the leg before the occurrence of the subject fall.
It was argued that the opinion of Dr Conrad would not provide evidence proving a causal nexus between the original injury and the fall “because [Dr Conrad] rather simply puts the answer in putting the question” (T34). It was further put that “nothing comes from Dr Conrad that says that weakness in her left foot is a legacy of the back injury”. It was put that there were any number of reasons why Ms Bishop’s fall may have occurred and the onus of proving a causal relationship to the original injury had not been discharged. Brief reference to the decision of the Court of Appeal in Kooragang Cement Pty Ltd v Bates (1994) 35 NSWLR 452 (Kooragang) was made.
Counsel appearing for Ms Bishop made reference to the written statement and oral evidence of her client concerning the occurrence of left leg collapse from “time to time”. It was put that Ms Bishop should be accepted as a witness of truth. It was further put that the day following the fall Ms Bishop, described by counsel as “an unsophisticated woman who doesn’t understand the legal concepts of whether something is compensable or not in terms of consequential losses”, gave a clear history to the general practitioner, Dr Mechreky, that she was walking along, felt something funny in her left leg and the leg gave way. It was further argued that the content of the medical expert reports corroborate Ms Bishop’s evidence concerning left leg pain. It was accepted by counsel that the records of Dr Mechreky did not contain reference to “leg giving way” until the consultation following the subject fall.
Counsel argued that, having regard to the CT findings made on 18 June 2010, there is evidence of “impingement at the L5 nerve roots and the exit foramen at the L5/S1 level bilaterally”. Reference was also made to the contents of medical certificates dating from July 2010 that make reference to “low back pain/left leg pain”. The point was made in argument that, whilst the certificates had reference to left leg pain, the general practitioner’s notes on occasions did not record such a symptom. Counsel argued that “the Court of Appeal says, the busy general practitioner is not expected to record every complaint that [a worker] has”. No authority was cited in support of that submission. It is likely that the argument was founded upon observations made by the Court of Appeal such as may be found in Nominal Defendant v Clancy [2007] NSWCA 349.
Counsel was questioned by the Arbitrator as to the availability, or otherwise, of evidence concerning any relationship between impingement of a nerve root and causation of the leg giving way. In response, counsel made reference to the evidence of Dr Silva whose report was relied upon by the employer. It was submitted that the views expressed by Dr Silva suggested that “if there had been some left sided sciatica or weakness from the neurological deficit, that is the pinched nerve, that would explain why it would be linked to the lumbar spine injury but because he says that’s not present, it’s not related”. That argument appears to suggest that, should the Arbitrator accept there was neurological deficit giving rise to sciatic pain, such may explain the collapse of the left leg.
Dr Silva’s report was the subject of lengthy exchanges between counsel and the Arbitrator. It was noted that Dr Silva did not appear to have had in his possession the CT lumbar spine conducted on 18 June 2010. It was also noted during that exchange that Dr Silva’s summary of the CT lumbar spine findings dated 2 March 2011 were “contradicted by the actual report itself” (per the Arbitrator at T54). At that point counsel for the employer responded to the Arbitrator by agreeing that there may be a contradiction between that which was stated by Dr Silva and that which appeared in the report. There followed a discussion between the Arbitrator and counsel concerning the requirements of proof as to causation. Counsel placed reliance upon the evidence of Dr Dan and that of Dr Conrad. It was put that “it would make no difference if [Ms Bishop] complained five times over the 11 years … or 100 times of left leg giving way”. It was put that the absence of recorded complaint concerning the leg giving way prior to the subject fall was “not fatal because of what the Court of Appeal says that a busy general practitioner … is not expected [to record every complaint]”. It was argued that it is clear that Dr Mechreky was not recording everything he was told by Ms Bishop and further that the evidence suggests that the condition of her back and her complaints by 2007 gave rise to the referral to Dr Dan, a neurosurgeon, who was consulted in December of that year. Dr Dan had reported that Ms Bishop had “developed back pain which resulted in problems with walking, sitting and lying”. It was Dr Dan’s view that the existence of sciatica suggests there would be a neural involvement or otherwise a referred pain. It was argued that the reports of Dr Dan demonstrate that he was of the view that there had been some sciatica experienced by Ms Bishop and that there was some sort of “neural involvement” which, as stated by Dr Dan, had not been demonstrated on any radiological studies. Counsel again referred to the evidence of Dr Conrad and emphasised that practitioner’s view that Ms Bishop had developed “some left sided non verifiable radiculopathy” and had expressed the view that the relevant fall was related to her back.
Counsel argued that the absence of recorded complaint by Dr Mechreky of the leg giving way was “not fatal” to Ms Bishop’s claim given that “even if Ms Bishop [didn’t have previous complaints such as left leg giving way], [Dr Mechreky] did take a clear history from her to days [sic, the day] following the incident that that’s what happened in that sequence” (T65). Counsel summarised her submissions by stating “you would be minded to accept [Ms Bishop’s] case that the left leg gave way as a consequence of her back injury and the injury to the ankle is as a consequence of that and is therefore compensable”.
Counsel for the employer, in reply, argued that there was an absence of expert evidence to establish that “the reason that the leg gave way is because of the impingement or the radiculopathy”. During exchanges with the Arbitrator counsel accepted that a history of the leg giving way had been given to Dr Mechreky by Ms Bishop on the day following the subject fall and agreed, as suggested by the Arbitrator, that “one could form the view that [the leg] gave way on that day”.

The Arbitrator’s decision

The Arbitrator noted that the employer had admitted injury to Ms Bishop’s lumbar spine and that it disputed “whether there is any connection between that injury and her left leg” (at [4] of Reasons).
The documentary evidence tendered by the parties was noted, but not summarised, by the Arbitrator (at [7] of Reasons). The Arbitrator then proceeded to summarise the evidence given by Ms Bishop when cross-examined by counsel. Reference was made to the content of Dr Mechreky’s clinical notes as recorded on the day following the subject fall. Submissions put on behalf of the parties were summarised. Some attention in that summary was given to the expert medical evidence, including the various radiological studies of Ms Bishop’s lumbar spine, to which counsel had referred in the course of argument.
The Arbitrator proceeded to address the issue in dispute concerning causation. Reference was made to those matters stated by Kirby P in Kooragang. The Arbitrator summarised relevant authority by stating that “a common sense evaluation of the causal chain is required”.
The Arbitrator proceeded immediately to conclude as follows (at [35]):
“In conducting that common sense evaluation to the facts and medical evidence in this case the causal connection between the work injury to the applicant’s lumbar spine on
6 May 2004 and the injury to the applicant’s left foot and ankle in her backyard on
25 June 2011 has not been established.”
The reasons stated for the conclusion noted immediately above are found at [36] of Reasons where it was stated:
“Firstly, the length of time between May 2004 and June 2011 is a significant factor for the applicant to overcome to make the relevant causal connection between the two events. A lengthy period of time between events, however is not determinative to deny the causal connection, see Kooragang. However, the length of time if elongated presents itself as a problem which is compounded by the complete lack of complaints of left leg collapses made by the applicant to medical practitioners. This is [sic] lack of recording of any complaint by Dr Mechreky who has been the applicant’s general practitioner during that period is telling. The factual evidence of such collapses of the left leg from the applicant herself do not make out a pattern of such an occurrence but only an occasional happenstance. Further, the medical evidence does not provide the cogent assistance to provide the necessary link in the causal chain. One therefore cannot have the requisite satisfaction that the event of the 25 June 2011 had such a connection. On this issue there will be an award for the respondent.”
The Arbitrator proceeded to make the orders as noted at [8] above.

SUBMISSIONS, DISCUSSION AND FINDINGS

This appeal is governed by the provisions of s 352 of the 1998 Act. The nature and scope of such an appeal is as provided by s 352(5):
“An appeal under this section is limited to a determination of whether the decision appealed against was or was not affected by any error of fact, law or discretion, and to the correction of any such error. The appeal is not a review or new hearing.”
The powers of the Commission upon conduct of such an appeal are defined by the provisions of s 352(7):
“On appeal, the decision may be confirmed or may be revoked and a new decision made in its place.
Alternatively, the matter may be remitted back to the Arbitrator concerned, or to another Arbitrator, for determination in accordance with any decision or directions of the Commission.”
The first ground relied upon by Ms Bishop suggests error of the Arbitrator in determining that “he was not satisfied that there was a causal link between the accepted back injury and the consequential left leg injury on 25 June 2011”.
That finding is found at [35] of the Arbitrator’s Reasons which has been noted at [45] above. The Arbitrator’s reasons for that finding were expressed at [36] of Reasons which are noted at [46] above.
The challenge raised by this ground thus concerns the Arbitrator’s factual finding as to the issue of causation. Such an error will be made out in those circumstances addressed by Barwick CJ in Whiteley Muir & Zwanenberg Ltd v Kerr (1966) 39 ALJR 505 (at 506), that is where:
“… material facts have been overlooked, or given undue or too little weight in deciding the inference to be drawn: or the available inference in the opposite sense to that chosen by the trial judge is so preponderant in the opinion of the appellate court that the trial judge’s decision is wrong.”
The second ground asserts error on the part of the Arbitrator in failing to give “proper reasons” for his determination of the disputed issue of causation. Such a contention raises a suggested error of law and necessarily requires a careful examination of the reasoning which led to the ultimate factual finding that causation had not been established. Unhelpfully, the submissions made in support of the appeal do not differentiate between the grounds relied upon. The thrust of Ms Bishop’s argument with respect to both grounds is to be found at [26] of submissions where it is put - “… there is overwhelming evidence of a causal link between the back injury, the left leg compromise and the event of 25 June 2011 and that [sic] the Arbitrator has failed to address that evidence and its significance”. In the circumstances it is proposed to address the grounds concurrently.
Before addressing those submissions made, it must be noted that in its opposition to this appeal the employer, by way of preliminary submission, argues that the grounds relied upon by Ms Bishop do not comply with the Commission’s Practice Direction No 6 (which prescribes the manner of particularising a ground of appeal) and “fail to reflect the limits imposed by s 352(5)”, that is, that an appeal is limited to determination of relevant error of fact, law or discretion. That argument can have no force or validity concerning Ms Bishop’s contention in ground two that the Arbitrator had erred in “failing to give proper reasons” for his determination. What is plainly suggested by Ms Bishop is that the Arbitrator has failed to provide sufficient reasons, as he is obliged, for concluding as he did concerning the issue of causation. Any such failure that may be established on this appeal would clearly constitute an error of law: Soulemezis v Dudley (Holdings) Pty Ltd (1987) 10 NSWLR 247 per Mahoney JA at 270.
It must be said that the employer’s preliminary submissions ([1] to [9]) which seek to challenge the ground of appeal suggesting factual error are less than lucid in their terms. However, it seems that the argument suggests flaws akin to the shortcomings found in grounds of appeal as discussed by Branson J in Sydneywide Distributors Pty Ltd v Red Bull Australia Pty Ltd (2002) 55 IPR 354; FCAFC 157 where it was stated (at [4]):
“A ground of appeal is a basis upon which the appellant will contend that the judgment, or a part of the judgment, should be set aside or varied by the Court in the exercise of its appellate jurisdiction. Not every grievance entertained by a party, or its legal advisors, in respect of the factual findings or legal reasoning of the primary judge will constitute a ground of appeal. Findings as to subordinate or basic facts will rarely, if ever, found a ground of appeal. Even were the Full Court to be persuaded that different factual findings of this kind should have been made, this would not of itself lead to the judgment, or part of the judgment, being set aside or varied. This result would be achieved, if at all, only if the Full Court were persuaded that an ultimate fact in issue had been wrongly determined. The same applies with respect to steps in the primary judge’s process of legal reasoning. Although alleged errors with respect to findings as to subordinate or basic facts, and as to steps in a process of legal reasoning leading to an ultimate conclusion of law, may be relied upon to support a ground of appeal, they do not themselves constitute a ground of appeal.”
Ms Bishop’s challenge raised in ground one is to a finding concerning an ultimate fact in issue, namely causation. If such error is made out Ms Bishop may be entitled to the relief prescribed by s 352(7). The employer’s preliminary submissions, which appear to seek dismissal of the appeal upon some unspecified basis (other than that the Arbitrator was correct in his conclusion) are rejected.
The question before the Arbitrator for determination was whether the injury of May 2004 had “resulted in” the alleged permanent impairment that was a consequence of the fall in June 2011: former s 66 of the 1987 Act. The Arbitrator identified the dispute as being “whether there is any connection between [the 2004 injury] and her left leg” (at [4] of Reasons). It may safely be assumed that the Arbitrator recognised that it was necessary to determine whether the impairment was causally related to the back injury.
When addressing that question of causation, the Arbitrator placed reliance upon that stated by Kirby P in Kooragang, in particular the statement by his Honour (at 463–464) that: “what is required is a common sense evaluation of the causal chain”. The Arbitrator’s conclusion concerning that question is noted at [45] above.
The Arbitrator’s reasons for concluding as he did concerning causation are noted at [46] above. That short statement is, in my view, correctly summarised by Ms Bishop in submissions as one demonstrating three distinct bases for his ultimate conclusion, they being:
“(1)   the length of time between the [back injury in 2004] and the event of 2011;
(2)     the lack of recording of complaints of left leg giving way;
(3)     the medical evidence did not provide the necessary link in the causal chain” (at page 2 of Submissions).
The first basis for his decision, the effluxion of a long period of time between the happening of the compensable injury and the fall, a period of seven years, was acknowledged by the Arbitrator as being “not determinative to deny the causal connection” (at [36] of Reasons). That observation correctly reflected what was said by Kirby P in Kooragang. In such circumstances, as his Honour stated, the causal question must be answered “on the basis of the evidence, including, where applicable, expert opinions.”
It is put by Ms Bishop that the seven year interval “is an irrelevant consideration”. That submission would not be made out if the Arbitrator’s conclusion as to proof of causation after such an interval was reached following a proper evaluation of the evidence and argument as advanced. That question is addressed below.
The second basis, being absence of record of complaint of leg “giving way”, was found by the Arbitrator, given the lack of recording by Dr Mechreky, the general practitioner who had attended Ms Bishop over the relevant period, to be “telling”.
The employer in submissions correctly records that Ms Bishop does not, and it asserts “she cannot”, challenge the accuracy of the Arbitrator’s finding that there is “a lack of recording of any complaint of [leg] collapse” (at [15] of Submissions). Ms Bishop’s argument is that “it was not necessary … to establish that there had been a recorded history of the left leg giving way”. It is further put by her that “it would have been sufficient to establish the causal connection even if it occurred only on one occasion, provided there was medical evidence to support the connection” (at [6] of Submissions).

It is abundantly clear from the cross-examination of Ms Bishop and from the employer’s submissions before the Arbitrator that a great deal of emphasis was placed upon the undisputed absence of any record in Dr Mechreky’s notes, or elsewhere, of the leg giving way before the fall. It seems that the Arbitrator has accepted that such matter was relevant to his deliberation as to causation. What is not apparent from either argument as advanced, or from the Arbitrator’s Reasons, is why such absence of complaint was relevant to that issue.
It is important to keep in mind the evidence of Ms Bishop concerning her experience, and reporting, of leg “giving way”:
(a)     in her statement the following appears (at [14]):
“My left leg had given way on several occasion, including when I was at work. The problems with my leg giving way had increased to the extent that my GP, Dr Mechreky sent me for an updated CT scan of my lumbar spine on 18^th June 2010.”
(b)     Ms Bishop was “not sure of how many occasions of giving way had occurred before the fall in June 2011” (T6);
(c)     she had told Dr Dan about her leg giving way following which that practitioner referred her for “a nerve test on [her] left leg” (T7);
(d)     she had told Dr Mechreky of the leg giving way (T8 and T9);
(e)     she was unsure if the leg had “collapsed by the first time [she had] seen Dr Dan”;
(f)     she had reported the left leg giving way to Dr Mechreky the day after the fall in 2011, and
(g)     she denied a suggestion in cross-examination that the leg had not given way prior to 26 June 2011 (T29).
It may be seen that Ms Bishop’s evidence is that, prior to the fall, she reported the “giving way” to two of her treating doctors, Dr Mechreky and Dr Dan. It is undisputed that such complaints had not been recorded by those practitioners. It was argued that caution should be exercised when regard is had to the content of records compiled by busy practitioners when consideration is given to whether particular inferences should be drawn.
Notwithstanding the tenor of the cross-examination concerning the absence of corroborating evidence concerning the “giving way”, no submission was put on behalf of the employer at the hearing before the Arbitrator that the credit of Ms Bishop concerning this matter was challenged. The highest it was put was that Ms Bishop’s “account is unreliable” (at T70). Counsel at that time confirmed, in response to the Arbitrator, that the argument was that Ms Bishop’s evidence on that point was “not persuasive”. Earlier it had been submitted by counsel (at T35–36):
“… when looking at whether the onus has been discharged, you have to look at whether the onus is discharged in the case where the injury occurs way away from the workplace, years removed from the injury which is said to be the injury upon which the employer’s liability is based. That onus is not discharged …”.
It may be seen that the evidence does not establish when the “giving way” first allegedly occurred, however it is clear by inference, upon acceptance of Ms Bishop’s evidence on this point, that it had occurred “on several occasions” a number of years after the back injury. That inference may be drawn from Ms Bishop’s evidence that she is not sure whether the leg had given way by the time she had first consulted Dr Dan, that being in December 2007.
The Arbitrator has stated that the absence of recorded complaint is “telling”. However, no finding was made rejecting the evidence of Ms Bishop that such was reported by her. Of significance is the acceptance by the employer that Ms Bishop had reported a giving way of the leg, on the occasion of the fall, to Dr Mechreky the day following the fall (at T69). It seems, but is not entirely clear, that the Arbitrator has accepted Ms Bishop’s evidence given his statement in the course of Reasons (at [36]): “the factual evidence of such collapses of the left leg from [Ms Bishop] herself do not make out a pattern of such an occurrence but only an occasional happenstance”. The real questions before the Arbitrator, in my view, were whether the evidence of “giving way” on the day of the fall should be accepted and, if so, whether, or not, the expert medical evidence supported the existence of a causal nexus between the back injury and the giving way of the leg.
The third basis upon which the Arbitrator concluded that causation had not been proven concerned that last mentioned question being the state, and force, of the expert evidence. It was found that such evidence did “not provide the necessary link in the causal chain”. It is Ms Bishop’s complaint that the Arbitrator has failed to give sufficient reasons for that conclusion.
The employer on this appeal seeks to support the Arbitrator’s conclusion on this question by making reference to the evidence of Dr Conrad, which is said to be deficient, and the evidence of Dr Silva and Dr Harrison. Leaving aside the merits of such argument, it is important to note that the employer suggests that the Arbitrator had discharged his duty to state sufficient reasons for his conclusion by stating the three reasons noted at [59] above.
I have earlier (at [54]) touched upon the nature of the obligation upon an Arbitrator to provide sufficient reasons for determination of a dispute. The existence of that obligation is clear having regard to the provisions of s 294 of the 1998 Act and Pt 15 r 15.6 of the 2011 Rules. The nature of the obligation upon a judge to provide reasons was examined in detail by Meagher JA in Beale v GIO of (NSW) (1997) 48 NSWLR 430 (at 442-444). The matters stated by his Honour are, in my view, relevant to the function of an Arbitrator of the Commission. In summary his Honour stated that, whilst “reasons need not necessarily be lengthy or elaborate” but “relate to the function to be served by the giving of reasons”, and that such reasons should demonstrate that all the evidence had been considered and why the relevant “findings of fact (and conclusions)” were made (at 443).
In the present matter the Arbitrator has recorded the competing submissions concerning the expert evidence. Some detail of that evidence is noted in the course of that summary. However, there is present in those Reasons no deliberation concerning the arguments advanced, nor any evaluation made by the Arbitrator of the expert evidence before reaching his conclusion which is noted at [45] above. Such reasons (noted at [46] above) as were expressed by the Arbitrator following the statement of his conclusion were not, in my opinion, sufficient to discharge the obligation upon him concerning provision of reasons. My further reasons for so concluding are stated below. That failure to provide reasons constitutes error, and for that reason alone the decision must be revoked on this appeal. The question remains as to whether, in all the circumstances, it is appropriate that, rather than remit the matter for hearing afresh before an Arbitrator, a new decision should be made in its place as is permitted by s 352(7).
I am of the view that a number of matters relevant to the question of causation have been either overlooked or been given “undue or too little weight” by the Arbitrator when reaching his conclusion that Ms Bishop had failed to establish relevant causal nexus. It is thus necessary to examine the evidence and submissions to determine the question as to whether, as put by Ms Bishop, relevant factual error was made.
It must be stated at the outset that the evidence relied upon by Ms Bishop concerning that question is scant. There are two medical expert witnesses whose evidence has been tendered by Ms Bishop who had examined her following the subject fall being Dr Conrad and Dr Harrison. It is apparent that Dr Harrison’s report tendered in her case was a copy of a letter forwarded to Dr Mechreky. A report had not been obtained from Dr Harrison by Ms Bishop’s solicitors for the express purpose of presentation in these proceedings and it is apparent, as one may expect, that Dr Harrison has given but cursory attention to the question of causal nexus when writing to Dr Mechreky. Dr Conrad’s opinion concerning that issue may be described as terse.
Notwithstanding the shortcomings of that evidence it is clear that the Arbitrator has made no evaluation of the evidence of Dr Conrad and, further, that no reference at all was made in the course of his Reasons to the evidence of Dr Harrison which had been referred to by counsel in the course of submissions (at T66).
The evidence of Dr Conrad relevant to causation appears in his report dated 14 December 2011 as follows:
“Ms Bishop did develop some left-sided non-verifiable radiculopathy and due to this weakness, she had a subsequent fall on 25 June 2011, in which she sustained a hairline fracture of the posterior malleolus of the left ankle and some ligamentous injuries and an injury to peroneus brevis tendon, as shown on MRI scan. She has ongoing pain in her back, some non-verifiable radiculopathy in her left leg and some pain and stiffness in the left ankle. She will need physiotherapy. I do not believe that any surgery or arthroscopy is indicated…
As a result of her work accident of 6 May 2004, complicated by the accident of 25 June 2011, which has a direct nexus to the 2004 accident on the basis of weakness in her left leg… [Dr Conrad proceeded to assess whole person impairment]”.
The evidence of Dr Conrad constitutes clear and unequivocal evidence of there being a causal nexus between the 2004 injury and the occurrence of the fall in 2011 and its consequences. It is noteworthy that Dr Conrad had not recorded a history of left leg giving way before the subject fall. Dr Conrad’s qualification to express an opinion was not in dispute. It is apparent that he has relied on the history, his knowledge and experience, as well as his observations during physical examination and the radiological findings to which he had access in reaching his views as expressed.
Dr Harrison had recorded in his report of 5 October 2011 that Ms Bishop had, after 2004 “started to experience episodes of mechanical low back pain and then left sciatic discomfort and that predisposed her to vulnerability to falls”. At page 2 of that report Dr Harrison expressed the view that further investigations were required as “the major component to her ongoing discomfort is not strictly ankle based but represents radicular pain affecting that left leg…”.
It may be seen that Ms Bishop’s case was founded upon the proposition that the back injury of 2004 had caused disc damage; with time that condition worsened and she developed radicular symptoms. Those symptoms manifested as left sided sciatica which in turn caused weakness and instability in that leg.
In addition to the evidence summarised above, Ms Bishop also relied upon those radiological studies which I have attempted to summarise at [30] above. Those studies demonstrated an indication of “potential impingement of the existing portions of both L5 nerve roots” - see CT lumbar spine 27 September 2007. The subsequent CT scan dated 18 June 2010 identified “impingement on the L5 nerve roots and the exit foramina at the L5/S1 level bilaterally”. Among the findings noted in the CT scan dated 2 March 2011 was “… likely impingement of the existing left L5 nerve root”.
Whilst some of the radiological evidence was mentioned by the Arbitrator when summarising submissions, there has been no evaluation of this material. What appears to have been overlooked by the Arbitrator is that the left sciatic symptoms as recorded by the eminent neurosurgeon Dr Dan from December 2007, suggested “neural involvement or otherwise a referred pain”. Dr Dan’s examination of March 2011, some weeks before the subject fall, recorded “pinprick was dull over the lateral left foot and two thirds of the leg, suggesting an S1distribution”.
The employer criticises the evidence of Dr Conrad (submissions [19] and [20]) by citing the history as recorded by him concerning weakness in the left leg and arguing that Dr Conrad “does not provide an opinion that the weakness in her left leg (which, in any case, had not been established), had resulted from the lumbar injury”. This submission fails to acknowledge the expression of opinion made by Dr Conrad which is noted at [77] above.
So far as proof of “weakness” is concerned it is clear that such complaint was made by Ms Bishop to Dr Conrad when history was recorded. Ms Bishop had not been challenged concerning that history. The consistent complaints recorded by Dr Mechreky in his clinical records of left leg pain and associated sensory symptoms clearly demonstrate that Ms Bishop was experiencing difficulty with that leg when walking and when at rest.
There is other evidence in Dr Mechreky’s notes which touch on the nature of Ms Bishop’s left leg difficulties, albeit recorded one day following the subject fall. It is of significance that when reference was made by the Arbitrator to that note (at [13] of Reasons) only a portion of the note was quoted, as follows:
“She felt something funny in her left leg (illegible) and gave way”.
There are two matters to note concerning Dr Mechreky’s record. Firstly, as recorded in the transcript (at T23-25), the Arbitrator and counsel made a concentrated effort to decipher all that appeared in that particular handwritten entry. Agreement was reached, but the “illegible” portion could not be deciphered. It appears to me that the notation in question records, following the word “leg” – “/knee”. Whilst I make no finding concerning the wording of the “illegible” portion, it must be noted that the word “and” does not, as stated by the Arbitrator, appear immediately thereafter.
The second matter to be noted is that the Arbitrator has not in his Reasons recorded the entirety of the note made by Dr Mechreky. It is, in my view, important that the note in its entirety be considered. It is not clear as to whether the Arbitrator had considered the entirety of the note which records:
“Pt. C/o exacerbation of low back pn
Pt said when she walking due to her back pain the leg not stable and yesterday when she walking at home she felt something funny in her L leg and her L leg(?/knee) give way and she twisted her ankle. Exacerbation of lower back pain. L ankle soft tissue injury”.
It may reasonably be inferred that the note, as recorded, reflects a history given by Ms Bishop that not only had she fallen the day before at home, but that the leg had in the past not been “stable” when walking “due to her back pain”.
The employer relied upon the evidence of Dr Silva, who expressed the view that he was not persuaded “that [Ms Bishop] had any significant lumbar spine disability that had contributed directly or indirectly for [sic] her rolling of the left ankle. There is no left-sided sciatica and there is no neurological compromise. There was only mild disc bulging at L4/5 and L5/S1 which revealed some gas in the L5/S1 disc” (report 30 September 2011).
That evidence must be considered in light of the following matters:
(a)     the history recorded, described by Dr Silva as “a long, rambling history”, does not include detail of the alleged fall in June 2011. The notation made by Dr Silva was that “[Ms Bishop] rolled her left ankle which became painful and she has not returned to work since”. The history of a “fall” on that occasion appears only under the heading in that report of “Present Complaints” where the following appears: “On this particular Saturday in June 2011 when she fell at home she rolled the left ankle in her backyard”. Dr Silva’s opinion, as noted above, appears to address contribution to “rolling of the left ankle” rather than possible causation of a fall by reason of radicular symptoms emanating from the lower back;
(b)     Dr Silva does not make any reference to the CT lumbar spine study conducted on 18 June 2010 (noted at [30(d)] above), and
(c)     Dr Silva, as noted by the Arbitrator at [26] of Reasons, “misquoted” the CT findings dated 2 March 2011. That matter had been raised by the Arbitrator with counsel for the employer (at T54). No explanation, such as to suggest that, perhaps, Dr Silva was expressing his own view of the films, was advanced at that time.
I have reached the view, having considered those matters noted above which appear to have been overlooked or given undue or too little weight by the Arbitrator in deciding the question as to whether causation had been established, that he was wrong to conclude that proof of such had not been made out. In my view, the progressive nature of Ms Bishop’s discal damage as demonstrated by the radiological studies, considered with the expert medical evidence discussed above establishes that the Arbitrator has erred in drawing those inferences which led him to his conclusion on this issue. I have earlier found that the reasons expressed by the Arbitrator for that conclusion were not, as is required, sufficiently stated. That such errors are interrelated may be evident from the matters which I have attempted to summarise in the course of the discussion above.
I find on this appeal that the fall suffered by Ms Bishop on 21 June 2011, and its consequences, resulted from the injury received by her on 6 May 2004.
In all the circumstances I am of the view that it is appropriate and in accordance with legislative intent that relevant orders be revoked and new orders be made in their place on this appeal. Given the finding noted immediately above, Ms Bishop is entitled to an order concerning payment of medical and associated expenses relating to treatment made reasonably necessary by reason of the fall. Appropriate orders appear below.

DECISION

Time to make this appeal is extended to 19 April 2013 pursuant to Pt 16 r 16.2(12) of the Workers Compensation Commission Rules 2011.
Paragraphs 2, 4, and 5 of the Certificate of Determination are confirmed.
Paragraph 1 is revoked and in its place the following order is made:
“1. The matter is remitted to the Registrar for referral to an Approved Medical Specialist for assessment of any additional whole person impairment of the applicant’s lumbar spine as a result of injury received on 6 May 2004, and of any whole person impairment with respect to her left lower extremity following a fall on 25 June 2011, which fall and any consequential loss is found to be causally related to that injury of 6 May 2004.”
Paragraph 3 is revoked and in its place the following order is made:
“3. The Respondent is to pay medical and associated expenses reasonably incurred in respect of treatment of her left lower extremity in accordance with former s 60 of the Workers Compensation Act 1987”.

COSTS

The respondent is to pay Ms Bishop’s costs of the appeal.

Kevin O'Grady
Deputy President

25 July 2013

I, MARGOT UNDERCLIFFE, CERTIFY THAT THIS IS A TRUE AND ACCURATE RECORD OF THE REASONS FOR DECISION OF KEVIN O'GRADY, DEPUTY PRESIDENT OF THE WORKERS COMPENSATION COMMISSION.

ASSOCIATE