Brown v TAC
[2011] VCC 1426
•5 December 2011
| IN THE COUNTY COURT OF VICTORIA | Revised |
Not Restricted
AT BALLARAT
CIVIL DIVISION
DAMAGES AND COMPENSATION
SERIOUS INJURY DIVISION
Case No. CI-09-05952
| NATALIE JOY BROWN | Plaintiff |
| v | |
| TRANSPORT ACCIDENT COMMISSION | Defendant |
---
| JUDGE: | HIS HONOUR JUDGE SACCARDO |
| WHERE HELD: | Ballarat |
| DATE OF HEARING: | 16 and 17 November 2011 |
| DATE OF JUDGMENT: | 5 December 2011 |
| CASE MAY BE CITED AS: | Brown v TAC |
| MEDIUM NEUTRAL CITATION: | [2011] VCC 1426 |
REASONS FOR JUDGMENT
---
SUBJECT – TRANSPORT ACCIDENT – Application pursuant to s.93(17)
CATCHWORDS – Serious injury
LEGISLATION CITED – Transport Accident Act 1986
JUDGMENT – Leave granted.
---
| APPEARANCES: | Counsel | Solicitors |
| For the Plaintiff | Mr J A Jordon SC with | Slater & Gordon Ltd |
| Mr T J Seccull | ||
| For the Defendant | Mr P D Elliott QC with | Solicitor for the Transport |
| Mr I S Gourlay | Accident Commission | |
| HIS HONOUR: |
1 In this matter, the plaintiff seeks leave to commence a proceeding claiming damages for injuries suffered by her by reason of a motor vehicle accident which occurred on 4 April 2002. The injuries relied upon by the plaintiff involve, firstly, an injury to the cervical spine; and secondly, the development of an Adjustment Disorder with Depression and Anxiety.
2 A primary issue which arises in the proceeding is whether the symptoms of which the plaintiff presently complains as being associated with the injury she has sustained to her cervical spine are organically sponsored or sponsored by a Pain Syndrome which is not organically-based. This issue turns largely upon discrete medical evidence and for this reason I am of the opinion that it is appropriate to make findings upon this issue at this point in my reasons, as my finding is likely to have a significant impact upon the approach which I adopt to the analysis of this application.
Are the Symptoms with which the Plaintiff Presents at the Present Time in her
Cervical Spine Caused by the presence of an Organic Condition?3 The medical evidence as to this issue is of relatively short compass and can be found principally in the medical reports of:
(i) The plaintiff’s treating general practitioners, Dr Frank Marton, Dr Carl Grace and Dr Michael Maher, the latter of whom also gave viva voce evidence in the course of the proceeding; (ii) The reports of the plaintiff’s treating chiropractor, Dr Julia Higgins; and (i) The reports of Mr Stephen Doig, a consulting orthopaedic surgeon, who was retained by the plaintiff’s solicitors to opine in the matter, and Mr Robert Dickens, a consulting orthopaedic surgeon, who was retained by the defendant’s solicitors to opine in the proceeding. 4 In a report dated 30 October 2008, Mr Doig said that the plaintiff presented to him in October 2008 with symptoms of pain in her left shoulder and her neck which was at that time being managed by the use of Panadeine Forte. On examination, Mr Doig reported that the plaintiff presented with limitations in flexion, extension and rotation of the cervical spine, with discomfort at extremes of movement. He described the presence of some spasm in the paraspinal musculature. Mr Doig diagnosed the plaintiff as having suffered a soft-tissue injury to her cervical and lumbar spines in the transport accident, from which she had made a reasonable recovery, but commented that she continued to complain of neck and back pain. He opined that the mechanism of the plaintiff’s injury was quite consistent with her presentation; that from an orthopaedic point of view, the plaintiff was stable; that while she had improved markedly over the period of eighteen months, the accident had nevertheless affected her quite markedly; that the plaintiff’s prognosis was “a little bit guarded”; and that “I think it is likely that she is going to continue to have some ongoing problems no matter what else is done”.
5 In a further report dated 9 March 2011, Mr Doig obtained a history from the plaintiff that her neck remained stiff and sore; that she suffered from ongoing headaches; found it hard to sit and to lean forward; and that she suffered from intermittent paresthesia radiating down towards the left hand. As to the plaintiff’s present treatment, Mr Doig commented:
“She is still on Panadeine Forte and nothing else.”
6 Mr Doig again diagnosed the presence of a soft-tissue injury to the cervical spine, a soft-tissue injury to the lumbar spine, and probable left subacromial bursitis, and commented:
“The injuries are consistent with the accident. The ranges of movement and clinical symptoms are really not a lot different from when I saw her 2½ years ago. She does complain of some ongoing pain in her left shoulder, the neck and low back but in fact she has a reasonable range of movement of all of these although not full. The paresthesia in her left hand she says is still intermittent and has not been further investigated.
…
From the orthopaedic point of view she is stable.
…
Again she says that this has affected her quite considerably. She finds it hard to sit and drive for long periods of time. She said that she had not returned to netball or dirt bike riding. She said that she attempted to water ski which she used to do before but it really markedly aggravated her left shoulder.
…
The prognosis here is only moderate. She has continued to have ongoing aching pain present and I think it is likely that that will continue for the foreseeable future.”
7 In a report dated 23 October 2010, Mr Robert Dickens obtained a history that the plaintiff suffered from cervical pain which extended into her left arm, which she described as having a severity of four out of ten on a visual analogue scale. The plaintiff told Mr Dickens that she was never pain free, that her pain was worse when travelling in a car, and that it was an everyday thing. She described her neck pain as being associated with headaches and dizziness and that apart from pain, she was aware of restricted mobility in her neck and a feeling of stiffness. She also complained of numbness in the ulnar three digits of her left hand.
8 On examination, Mr Doig opined that he thought that the plaintiff’s range of movement in her cervical spine was full but that she was tender in the cervical spine in the C4-5-6 region. He described the plaintiff’s reflexes and power as being normal but documented a sensory alteration which conformed with the C8 dermatome.
9 Dr Dickens opined that he agreed with Mr Doig’s assessment that the plaintiff had suffered a soft-tissue injury to her cervical spine and to her lumbar spine, and a soft-tissue problem with her left shoulder with subacromial bursitis by reason of her involvement in the motor vehicle accident. He opined, however, that:
“… one would have expected that soft-tissue injuries of this nature would have resolved with time and in fact they have not. I am unable to explain that on clinical findings and the special investigations that we have available to us … I would have expected any soft-tissue injuries of a nature described to have resolved over a period of a year and I am unable to explain why this incapacity has persisted for 8 years. I can only assume that there is some non-organic component to her complaints.”
10 In a report dated 1 October 2004, Dr Michael Maher reported that he had examined the plaintiff on 19 April 2002, at which time his examination revealed the plaintiff to be presenting with a full range of movement of her cervical, thoracic and lumbar spines. He opined that the plaintiff had suffered soft-tissue injuries and recommended Nurofen for treatment of those injuries.
11 Dr Maher arranged for the plaintiff to undergo an MRI scan of her left shoulder and cervical spine on 6 November 2006. The plaintiff was at that time shortly to turn twenty-six years of age. The MRI scan is reported as revealing the presence of desiccation of C2-3 to C5-6. The report concludes as follows:
“Desiccated cervical discs. A mild degree of posterior disc/osteophyte complex at C3/4 level effacing the theca and mildly contacting the anterior aspect of the cervical cord.”
12 In a further report dated 15 June 2008, Dr Maher stated that he was in possession of the plaintiff’s medical file extending back to 1987 and that:
“… consultations prior to the RTA bear very little resemblance to those subsequently due to their absence of issues in relation to pain, medication dependence or psychological problems.”
13 He reported that following her attendance upon him on 19 April 2002, the plaintiff re-presented to his practice in December 2004:
“… and it became obvious that in the interim she had developed chronic anxiety and pain problems. She was dependent on Panadeine Forte and described constant left chest and shoulder pain, and neck pain. She had seen a number of other practitioners and was concerned about her analgesic usage. A plan was made to reduce her painkiller usage and to try and focus on improving her functioning. She was referred to the pain management clinic.”
14 Whilst the majority of Dr Maher’s report deals with the effect of the plaintiff’s chronic anxiety and symptoms of depression following the accident, he opined as to the organic injury which the plaintiff had suffered to her spine:
“She suffers from ongoing chronic pain related to soft tissue injuries to
the neck, chest wall and left shoulder …”
15 In his final report dated 27 February 2011, Dr Maher opined that the physical effects of the plaintiff’s soft-tissue injuries to her neck, chest wall and left shoulder were ongoing. He commented that the plaintiff required regular analgesia; that pain management had been an issue at times as the result of her psychological problems; that it was likely that she would continue to require some form of analgesia for the indefinite future and that it was hoped that her analgesic requirements would not increase in the future. He said that whilst there had been issues with dependence on medication in the past, these issues now appeared to be resolved, and that whilst the plaintiff had a capacity for work, as the result of her injuries, she had a reduced capacity for manual work, including lifting, bending and carrying, particularly repetitive or heavy duties. He described these restrictions as being likely to continue indefinitely.
The viva voce Evidence of Dr Maher
16 In the course of evidence-in-chief, Dr Maher gave evidence that the plaintiff was presently being prescribed Panadeine Forte, the usage of which was being monitored both by himself and the chemist dispensing the medication for the purpose of “trying to maintain an appropriate amount of usage and not overdoing it”. He described the plaintiff’s current prescription as being “eight tablets per day, or up to eight tablets a day, depending on her pain levels but she fairly consistently using eight a day”. (sic).
17 In cross-examination, it was put to Dr Maher:
(i)
that following the accident, the plaintiff had presented at the Ballarat Hospital (“the hospital”) where, on examination, she was conscious and alert, and while she was complaining of left neck, ribs and shoulder pain, she was diagnosed as having sustained no injury;
(ii)
that in April 2002, the plaintiff had presented to the hospital with episodes of chest pain made worse by movement or deep inspiration and pain in her left arm; that an examination which was undertaken was normal apart from the suggestion of mild tenderness over the left side of the chest; that she was prescribed Panadeine Forte, which resulted in an improvement in her pain;
(iii)
that on 13 April 2002, the plaintiff presented at the Emergency Department of the hospital with back, chest and arm pain and on examination, she was generally tender over the spine:
“… particularly thoracic and cervical spine and she had chest wall
tenderness.”
18 Dr Maher was also taken to his examination of the plaintiff of 19 April 2002. Dr Maher was questioned as to the findings of the MRI scan of 6 November 2006 and commented that the scan revealed the presence of “some degenerative type of changes”.
19 On the basis of this material, it was put to Dr Maher that it was difficult to explain the plaintiff’s complaint of pain in her neck continuing for some ten years as being organically-based if she had merely suffered a soft-tissue injury in the accident, to which Dr Maher replied:
“I don’t think that’s difficult to explain. I think that’s not an uncommon scenario or situation that soft tissue injuries routinely don’t show up on scans and X-rays and it’s quite common to develop pain and tenderness over a period of time after an injury like that.”[1]
[1] Transcript 81
20 While it was further put to Dr Maher that the plaintiff’s continuing complaints of pain were better explained in terms of “the psychological label of a Pain Disorder or Pain Syndrome”, Dr Maher opined:
A:
“I would disagree with that. I think that the symptoms fit with the injuries that occurred in terms of pain and I certainly have seen many people with similar persistent pain after a similar type of injury. I don’t think a pain syndrome is exclusive of organic pain and that in my opinion that – there is an underlying organic basis, it’s not a purely psychological condition.[2]
Q: And what do you say the organic basis of her complaints are?--- A:
I think it’s from the trauma of the car accident in which she was injured. Her soft tissues were injured at the time of the car accident.”
[2] T 87
21 The cross-examination of Dr Maher concluded with the following questions and answers:
Q: “Doctor, with a soft-tissue injury, you don’t think that it’s unusual to have somebody complaining of this level of pain following on that accident for this period of time for years?--- A: As I said before, the – it’s certainly something that we see on a regular basis. The duration and intensity of the pain would be less common and in reference to your previous questions about you know, is the pain purely a pain syndrome or is there an injury that’s causing the pain, I would say that there are both as in the pain is there, it’s – I think we can reasonably believe that’s the case but for someone who has psychological problems with anxiety and depression, it’s quite common for pain to be worse. Their perception of pain is increased. Q: You were saying that the complaints, the symptoms are a combination of underlying soft tissue plus the psychological aspect? A: Yes.”[3] [3] T 93
22 In re-examination, Dr Maher was taken to the results of the MRI scan of 18 October 2006 and commented as to the reported findings:
“… I think it’s – it would be unusual for someone of that age to have desiccated discs and the disc and osteophyte complex at C3 and 4. It is – those would be consistent with a previous injury or degenerative changes following an injury.”[4]
[4] T 94
23 In a medical report dated 3 October 2008, Dr Carl Grace commented that the plaintiff presented at his practice on 6 January 2003, at which time she was examined by his locum tenens, who prescribed Feldene capsules as an anti- inflammatory medication and Panadeine Forte as an analgesic, having obtained a history from the plaintiff that she had “had a road traffic accident and was still getting pain in the chest, over the sternum and the left shoulder”.
24 He reported that on 17 July 2004, the plaintiff was examined by a locum tenens at his practice, who recorded that the plaintiff was suffering from a migraine-type headache with visual disturbance related to a motorcar accident and that it was thought that those symptoms may be neck-related. At that time, Panadeine Forte was prescribed as an analgesic and Diazepam tablets were prescribed as a muscle relaxant.
25 In reports dated 27 September 2004 and 13 August 2005, Dr Frank Marton, a general practitioner, describes attendances by the plaintiff at his practice between September 2003 and June 2005, which were principally related to the management of the plaintiff’s mental health.
26 In the body of his report, Dr Marton:
[5] The timing of these prescriptions is unclear from his report.
• describes providing the plaintiff with anti inflammatory medications and Panadeine Forte during this period;[5] • states that in November 2003, the plaintiff was referred for rehabilitation; that she had undergone laser acupuncture in January 2004; had attended physiotherapy until approximately August 2004; and had been referred in September 2004 for an injection of cortisone into her left shoulder. 27 As at 27 September 2004, Dr Marton described the plaintiff as presenting with bursitis in her left shoulder and Chronic Pain Syndrome involving her back and anterior chest wall.
28 In his report dated 13 August 2005, Dr Marton opined that the plaintiff:
“… has developed a Chronic Pain Syndrome/Fibromyalgia where even gentle physiotherapy stirs her up to the point where she has to sleep sitting up in a chair, because of back and left shoulder pain, after gentle treatment.”
29 In a report dated 2 July 2008, Dr Julia Higgins, a chiropractor, states that the plaintiff presented to her practice on 30 May 2002, at which time she described having suffered:
“… a whiplash/lap sash type of injury causing neck and jaw pain, left
shoulder pain, left anterior chest pain, headaches and anxiety attacks”.
30 Dr Higgins treated the plaintiff on four occasions between May 2002 and August 2002 and then did not see her until she re-presented on 22 February 2005. At the time at which she authored her report, Dr Higgins had most recently seen the plaintiff on 11 April 2008 and opined that the plaintiff had suffered:
“… a moderate, post-traumatic biomechanical dysfunction of the cervicothoracic junction and left costochondral wall with associated paresthesia and myospams and complicated by psychological overlays. For these injuries, it is reasonable that Natalie may require passive musculoskeletal therapy for relief of pain and stiffness. A routine combination of remedial massage alternated with chiropractic would not be unreasonable. Unfortunately, I do not see this as a temporary schedule of care, rather one that may well continue throughout Natalie's life.”
31 She concluded her report, commenting:
“Natalie would be well suited to non-physical, office style employment. She is a naturally intelligent and bright young lady. She is good with people and children. Re-training and further education may be required for her to reach her full potential …”
Finding as to whether the symptoms with which the plaintiff presents at the present time in her cervical spine were caused by the presence of an organic condition?
32 The general tenor of the medical evidence to which I have referred supports the fact that the plaintiff suffered a soft-tissue injury in the motor vehicle accident which has had lasting consequences. Mr Doig, Dr Maher, Dr Higgins and the locums who treated the plaintiff at the practice of Dr Grace were clearly of the opinion that, on the occasion on which they last examined the plaintiff, that this was the case.
33 Further, the plaintiff’s long history of pain management via the prescription of Panadeine Forte, which prescribing practice has been maintained by a number of treating doctors, also suggests the presence of a significant organic Pain Syndrome.
34 In addition, I find the opinion expressed by Dr Maher in the course of his viva voce evidence that the MRI finding of 6 November 2006 (which reported the presence of desiccation between the C2-3 and C5-6 cervical discs) was an unusual finding in the absence of trauma given the plaintiff’s age at the time at which this examination took place, to provide persuasive support for:
• the fact that the accident occasioned an injury to the plaintiff’s cervical spine which had the potential of causing long term consequences; • the presence of an organic condition being responsible for the plaintiff’s persisting symptoms. 35 The impression I obtain from Dr Marton’s report is that he was concerned principally with the management of the plaintiff’s acute presentation with Depression and a generalised Anxiety Disorder.
36 Given Dr Marton’s prescription of Panadeine Forte for the management of the plaintiff’s symptoms (which would be unlikely, in my opinion, to be prescribed for the management of other than organically-based pain), it is unclear to me whether Dr Marton’s employment of the term “Chronic Pain Syndrome – fibromyalgia” when describing the plaintiff’s presentation, is a reference to an organic or non-organic condition. For this reason, I find it difficult to discern Dr Marton’s position upon the issue as to whether the plaintiff was presenting with organic pain, and accordingly, I find his report to be of little assistance in reaching a decision as to the present issue.
37 Whilst the defendant relies upon the opinion of Mr Dickens, in which he commented that he was unable to explain why the plaintiff’s incapacity had persisted for eight years, and concluded:
“I can only assume that there is some non-organic component to her
complaints.”
to support its position that the plaintiff presents with a principally non-organic condition, I considered the opinion expressed by Mr Dickens to be an opinion which falls well short of excluding the presence of an organic injury or of expressing the opinion that a continuing organic injury is not a cause of the plaintiff’s presentation.
38 Finally, I take into account the medical opinions of Dr David Weissman, Dr Nathan Serry and the plaintiff’s treating psychologist, Mr Alex Montgomery.[6] Each of these doctors, when opining as to the plaintiff’s psychiatric condition, have expressed the opinion the plaintiff presents with a ”Pain Disorder
Associated with both Psychological Factors and a General Medical Condition”
as that phrase is defined by the DSM IV Guidelines. These opinions clearly recognise the importance of both psychological factors and the plaintiff’s general medical condition[7] in the onset and maintenance of her pain.[8]
[6] T 110
[7] Which I interpret as being a reference to the plaintiff’s organic injury –see in this regard the evidence of Mr Alex Montgomery at T 110.
[8] See PCB 132J and DCB 41
39 Having considered the totality of the medical evidence, I am satisfied, for the reasons which I have expressed, that the symptoms of which the plaintiff complains in her cervical spine stem largely from the presence of an organic condition which, having regard to the period of time during which it has persisted, is likely to continue at its present level into the foreseeable future.
Are the Consequences of the Injury to the Plaintiff’s Cervical Spine “serious” as defined by Section 93(17) of the Transport Accident Act 1986?
40 In her affidavit dated 3 October 2008, the plaintiff said:
•
that she struggled with chronic pain in her neck, back and left shoulder on a daily basis;
•
that she struggled to sleep at night due to pain and that she could only get approximately five hours of sleep a night by reason of the fact that her neck pain kept her awake;
•
that while she was able to cope with the work which she was currently undertaking at Mulvra Place, an aged-care facility in which she was working as a trainee, she found that the work exacerbated the condition in her neck and back, but that she managed the work because she was able to take regular rest breaks; and
•
that the pain she experienced in her “spine and in particular my neck and left shoulder” greatly restricted her ability to undertake physical work, and significantly interfered with the physical activity in which she engaged.
41 In her further affidavit of 26 May 2011, the plaintiff said that her neck pain:
• was responsible for frequent headaches; • caused her neck to feel “stiff and jammed”. It is painful and the intensity of such pain varies on a day-to-day basis; • caused her difficulty whilst driving and when engaged in activities which required her to adopt a “fixed type of position including reading, computer use and the like”, and that she continued to have difficulty sleeping. 42 The plaintiff said:
•
that she had left her employment with Mulvra Place and commenced employment at “Home Care Plus” which involved caring for the elderly “predominantly in the client’s home”;
•
that whilst she enjoyed her work and the relative financial security which that work provided, towards the end of 2009, the nature of the work became more physical and that the resulting exacerbation of her neck and shoulder symptoms caused her to approach her employer to seek lighter duties. She said that whilst she had previously been working approximately twenty hours a week and on occasions additional hours on a Saturday and Sunday; the change to restricted duties resulted in her being provided with between four and seven hours’ work on a three to four-week basis. She said that for this reason she had discontinued her employment in August 2010, at which time she “realised that physical
work was now beyond me and I needed to change the type of work that I
did”;
•
that activities such as driving, watching a movie, exercising, performing housework, shopping, sleeping and socialising with family and friends, were adversely affected by her neck injury.
The Plaintiff’s viva voce Evidence
43 Virtually all of the viva voce evidence given by the plaintiff centred upon the history and consequences of her psychiatric condition. The brief evidence given by her as to the consequences of her cervical injury tended merely to confirm and amplify the statements by the plaintiff in her affidavits.[9] In this regard, it was appropriately conceded on behalf of the defendant that those statements were not challenged.[10]
[9] See the plaintiff’s evidence at T 30 L22; T58 L20 – T62 L15; T 70 L7 – T 71 L20
[10] T 154
Finding
44 No issue was taken as to whether the description by the plaintiff as to the consequences to her of her neck pain as described in her affidavits was accurate. Nor is there any issue that the restrictions of which the plaintiff complains are present, notwithstanding the ingestion by the plaintiff of very significant quantities of Panadeine Forte.
45 It is the general tenor of the medical evidence to which I have referred that the condition of the plaintiff’s cervical spine is now largely stable and I am satisfied that this is the case. Further, the opinion expressed by Dr Maher as to the plaintiff’s continuing need for medication, namely that:
“It is likely she will continue to require some form of analgesia for the indefinite future. It is hoped that her analgesic requirements will not increase in the future”
suggests the probability that the plaintiff’s reliance on Panadeine Forte will
continue at very high levels for the foreseeable future.46 Equally, I am satisfied, having regard to the plaintiff’s evidence as to the restrictions which her condition imposes upon her lifestyle, that the quantity of medication which she employs reflects the severity of the pain which she is experiencing.
47 Whilst the evidence does not exclude the possibility that the symptoms which the plaintiff experiences in her chest wall, back and left shoulder, may contribute to her need to employ Panadeine Forte to manage those symptoms, I am satisfied, having regard to the description by the plaintiff in her affidavits of the symptoms emanating from the condition in her cervical spine, that this condition is a significant contributing factor to the ingestion by the plaintiff of the levels of Panadeine Forte which she uses.
48 That a young person is required to ingest such large quantities of prescription- strength medication on a long-term basis in management of her pain, is, in my opinion, even when considered in isolation to the other adverse impacts associated with the injury to the plaintiff’s cervical spine, a consequence which is appropriately described as being at the very least very considerable.
49 I accept the plaintiff’s evidence that the condition in her cervical spine precludes her from engaging in work involving even moderate levels of physical activity such as that which she undertook whilst employed by Home Care Plus[11] and that this restriction has to date adversely impacted upon the plaintiff’s financial security. Further, the evidence satisfies me that even should the plaintiff successfully complete her retraining, it remains uncertain as to whether her physical condition will allow her to present to a potential employer as a reliable employee.
[11] See the plaintiff’s evidence at T70-17
50 Taking these matters into account, and considering them together with:
(i) the plaintiff’s young age; (ii) the long history of physical pain which the plaintiff has endured to date; (iii) the effect of the plaintiff’s neck pain upon her life, in that it:
ƒ is responsible for frequent headaches; ƒ restricts her ability to engage in activities which require her to
adopt a fixed position, including basic everyday activities such as driving a car; watching a movie; exercising; reading and using a computer;
ƒ interferes with the plaintiff’s ability to sleep;
I am satisfied that the consequences of the injury to the plaintiff’s cervical spine, when considered in isolation of the consequences to the plaintiff of the Adjustment Disorder with Depression and Anxiety from which she suffers, give rise to an impairment, which, when judged by comparison with other cases in the range of possible impairments or losses, can be fairly described as being at least “very considerable” and certainly more than “significant” or “marked”.
51 For these reasons:
(i) I am satisfied that the plaintiff is entitled to the leave which she seeks in this application; and, accordingly: (ii) I do not consider it to be necessary to make findings as to the consequences to the plaintiff of the Adjustment Disorder with Depression and Anxiety from which she suffers. 52 Further, given my findings, it is unnecessary for me to determine the issue which arose in this matter as to the significance of the symptoms suffered by the plaintiff between the accident date and the hearing date, in assessing whether the impairment consequences of her injury are appropriately described as being “long-term” within the meaning of the Act.
53 I will hear the parties as to the precise form of the order which is sought in the proceeding and also upon the issue of costs.
- - -
0
0
0