Cib v State of NSW (NSW Police Force)

CERTIFICATE OF DETERMINATION OF MEMBER
CITATION:	CIB v State of NSW (NSW Police Force) [2025] NSWPIC 371
APPLICANT:	CIB
RESPONDENT:	State of NSW (NSW Police Force)
MEMBER:	Kathryn Camp
DATE OF DECISION:	1 August 2025
CATCHWORDS:	WORKERS COMPENSATION - Workers Compensation Act 1987; sections 4(a), 4(b)(i), 4(b)(ii), and 9A as it stood prior to the 2012 amendments; whether applicant sustained an injury to which employment was a contributing factor; whether employment was a substantial contributing factor to any injury; exposure to traumatic events as a police officer; lack of contemporaneous complaint; causation; contemporaneous stressors related to non-work court proceedings; Kooragang Cement Pty Ltd v Bates, Badawi v Nexon Asia Pacific Pty Limited t/as Commander Australia Pty Limited, Fletcher International Exports Pty Limited v Barrow, AP v New South Wales Police Force, Chanaa v Zarour, and Department of Education & Training v Sinclair considered and applied; Held – applicant sustained a psychological injury in the course of her employment with the respondent; employment was a substantial contributing factor to the injury; incapacity and need for medical treatment a result of the injury; award for the applicant for weekly benefits and medical expenses; publishable decision to be de-identified in accordance with rule 132 of the Personal Injury Commission Rules 2021.
DETERMINATIONS MADE:	The Commission determines: 1. The respondent is to pay the applicant weekly compensation as follows: (a) from 19 March 2024 to 19 September 2024, $1,607 per week pursuant to s 36 of the Workers Compensation Act 1987; (b) from 20 September 2024 to 30 September 2024, $698.10 per week pursuant to s 37 of the Workers Compensation Act 1987; (c) from 1 October 2024 to 31 March 2025, $705.20 per week pursuant to s 37 of the Workers Compensation Act 1987, and (d) from 1 April 2025 to date and continuing, $718.20 per week pursuant to s 37 of the Workers Compensation Act 1987. 2. The respondent is to pay the applicant’s reasonably necessary medical and related treatment expenses in accordance with s 60 of the Workers Compensation Act 1987 on production of accounts, receipts and/or Medicare notice of charge. 3. The publishable decision is to be de-identified pursuant to r 132 of the Personal Injury Commission Rules 2021, to de-identify the applicant named in the proceedings. 4. The respondent to pay the applicant’s costs as agreed or assessed. 5. I order an uplift of 20% for complexity in respect of costs for both parties for two separate hearing events, in accordance with Table 4 of Pt 2 of Sch 6 of the Workers Compensation Regulation 2016. 6. Liberty to apply in respect of the quantum of weekly payments in order [1]. A brief statement is attached setting out the Commission’s reasons for the determination.

STATEMENT OF REASONS

INTRODUCTION

This matter concerns a claim for weekly benefits and medical treatment expenses for an alleged psychological injury, as a result of exposure to a series of traumatic incidents over the course of work as a police officer. For the reasons discussed below, the worker’s claim for compensation is successful.

BACKGROUND

In 2011, [CIB], the applicant worker, commenced work with the NSW Police Force as a police officer. The applicant took leave from work on or about 19 March 2024, and has not returned to employment. Around the time of her leave from work the applicant was going through personal matters, including family court proceedings involving her child and apprehended violence order proceedings against her and her father.
The applicant alleges that during the course of her employment with the respondent, she had been exposed to a series of traumatic incidents which led her to suffer a psychological injury.
The respondent’s insurer issued several notices and reviews pursuant to ss 78 and 287A of the Workplace Injury Management and Workers Compensation Act 1998, dated 2 April 2024, 17 May 2024 and 29 January 2025, declining liability for compensation for the alleged psychological injury.
On 14 February 2025, the applicant commenced proceedings in the Personal Injury Commission (Commission) under cover of an Application to Resolve a Dispute in respect of a claim for weekly benefits and medical treatment expenses in relation to a psychological injury dated 19 March 2024.

ISSUE FOR DETERMINATION

The following issues remain in dispute:
(a)    whether the applicant sustained a psychological injury deemed to have occurred on 19 March 2024 (ss 4, 9A and 11A(3) of the Workers Compensation Act 1987 (the 1987 Act));
(b)    whether the applicant has an entitlement to weekly payments of compensation for the period 19 March 2024 and ongoing (Div 2 of Pt 3 of the 1987 Act), and
(c)    whether the applicant has an entitlement to the claimed past and future medical expenses (s 60 of the 1987 Act).

The following matters are agreed:
(a)    the applicant is an “exempt worker” and the amendments made by the Workers Compensation Legislation Amendment Act 2012 do not apply in respect of the alleged psychological injury;[1]
(b)    that the applicant was exposed to traumatic incidents in the course of her employment with the respondent, and
(c)    subject to a finding on injury, the parties agree that the applicant has total incapacity and requires ongoing medical treatment for her psychological condition.
[1] Workers Compensation Act 1987, cl 25 of Pt 19H of Sch 6.

PROCEDURE BEFORE THE PERSONAL INJURY COMMISSION

On 1 April 2024, the parties attended a preliminary conference during which the issues in dispute were agreed and confirmed.
On 16 May 2025, the parties attended a conciliation conference and arbitration hearing. Mr Stanton, of counsel, appeared for the applicant instructed by Brydens Lawyers. Mr Stockley, of counsel, appeared for the respondent instructed by Rankin Ellison Lawyers.
The parties were unable to reach a resolution by agreement during the conciliation phase of proceedings. The matter proceeded to arbitration hearing, during which I heard and declined the respondent’s three interlocutory applications. Firstly, an application for leave to lodge and admit clinical records of psychologist Leanda Howell. Secondly, a reconsideration of my decision to refuse that first application. Thirdly, an application to exclude the report of Leanda Howell (ARD page 95). Those reasons have been recorded.
This matter was part-heard on 16 May 2025, and due to various matters including time constraints and availability of counsel, the matter was stood-over to 30 June 2025 to allow the same counsel the opportunity to provide oral submissions on the substantive issues in dispute.
Prior to hearing submissions on 30 June 2025, the respondent confirmed its earlier position that it disputed injury and its concession that if there was a finding on injury in favour of the applicant she had an entitlement to the weekly benefits and medical expenses claimed. The matter proceeded to a recorded hearing and oral submissions were made by counsel.
I am satisfied that the parties to the dispute understand the nature of the application and the legal implications of any assertion made in the information supplied. I have used my best endeavours in attempting to bring the parties to the dispute to a settlement acceptable to all of them. I am satisfied that the parties have had sufficient opportunity to explore settlement and that they have been unable to reach an agreed resolution of the dispute.

EVIDENCE

Documentary evidence

The following documents were in evidence before the Commission and considered in making this determination:
(a)    Application to Resolve a Dispute (Application), dated 14 February 2025, and attached documents;
(b)    Reply to Application to Resolve a Dispute (Reply), dated 10 March 2025, and attached documents;
(c)    Directions issued on 1 April 2025 and 19 May 2025;
(d)    Application to Lodge Late Documents (ALAD-1), lodged by the respondent on 20 May 2025, and
(e)    Application to Lodge Late Documents (ALAD-2), lodged by the applicant on
28 May 2025.
The ALAD-1 was admitted into proceedings, by consent, limited to Ms Howell’s hand written clinical notes and her report to Unified Healthcare Group Pty Ltd, dated 22 February 2025.
The ALAD-2 was also admitted into proceedings, by consent, together with the documents attached to the Application and Reply.

Applicant’s statements

In evidence are two statements of the applicant, dated 6 February 2025 and 27 May 2025.
In her first statement, the applicant notes she joined the police academy in March 2011 and attested in December 2011. She states that she has no prior or relevant past psychological injuries. She also states that her mental state was stable prior to the injury.
The applicant states that she was exposed to several traumatic incidents in her role as a police officer over 13 years. She notes these incidents related to attending scenes of murder, suicides, fatal motor vehicle accidents, recovery of deceased persons, sexual assaults, and child pornography. She states that her mental state began to “deteriorate within a few months” of employment, and refers to a specific incident involving a deceased child in a burned down caravan. She states that she sold her caravan as a result of this incident. She also refers to an incident on Melbourne Cup Day in 2021 where she talked to a young person and encouraged him to change his life but then saw him commit suicide by jumping over a concrete wall. On return to the station she states that she “hysterically cried for a lengthy period of time”.
The applicant states she was not adequately counselled following the caravan incident and did not ask for help because she was junior and “too scared to speak up”, but was encouraged to use alcohol as a “coping mechanism”. She claims that as a result of this incident she developed bulimia and lost 12kg of weight over six to 12 months. She states she was referred to a Police Medical Officer for her weight and fatigue issues but was “unable to ask for help and speak [her] truth in fear of being outcasted”.
The applicant states that she began to notice that her “sleep became increasingly disturbed” and she “struggled with distressing memories and nightmares about all [of her] traumatic experiences at work”. She had night sweats and would wake bleeding from scratching her skin due to the nightmares. She adds that she would cry on her commute to work and have panic attacks in her car on arrival at the station. She states she could no longer ignore the traumatic exposures by mid-February 2024.
The applicant claims that she suffered multiple skin rashes due to her injury leading up to February 2024.
The applicant records her current symptoms. She states that she struggles with a lack of motivation or desire to do anything, and daily living. She also states that as a result of the injury she struggles with “relationships and intimacy.” She states that her “previous long-term relationship with [her] partner of 6 years broke down due to the lack of [her] motivation and intimacy.”
In her supplementary statement, the applicant confirms that she has been unemployed since her injury on 19 March 2024.

Medical evidence

Dr Cranney’s Medical Practice

In evidence are the clinical records of the applicant’s treating general practitioner, Dr Cranney (or his colleagues at the same medical centre). The applicant attended on Dr Cranney for treatment from the time she was an infant. The relevant entries, to which the parties refer, have been extracted below.
On 4 August 2010, Dr Almut Von Schwedler, general practitioner, records that the applicant was hoping to join the police force next January. He records “gained excessive weight, aged 17”. Her weight is recorded at 65kg at the time of the consultation.
On 9 July 2012, Dr Cranney records the applicant’s weight at 63kg.
On 26 October 2012, Dr Cranney records that the applicant was on probation with the police force until medical clearance and that her supervisor said that there was an issue with her weight. Dr Cranney also records that the applicant’s “weight decreased 10 kg in last year but pt said that yrs ago she was over 80kg”. Her weight is recorded at 53kg. The diagnosis is recorded as anxiety and bulimia nervosa.
On 29 October 2012, Dr Cranney records the applicant’s reason for visit is for a mental health care plan “refer john Labone at KMC, AXIOM”. It notes the applicant is living at home and there are issues with her boyfriend. It also records anxiety as a reason for the visit. Her weight is recorded at 53kg. She is prescribed Zoloft.
On 31 October 2012, Dr Cranney records a “new care plan (nil previous)” and that the applicant needs a referral to a dietitian for healthy eating and attitude towards weight.
On 22 November 2012, Dr Cranney records a message from a Ms Higgins seeking that a “referral for Axiom Psych” be sent.
On 8 September 2014, Dr Cranney records that the applicant is told by work to get blood tests “as ?anorexia/fatigue/poor sleep”. He notes that she did not take Zoloft. Her weight is recorded at 59.5kg. The diagnosis is recorded as “[i]nsomina” and the reason for visit is the same and “previous wt issue”. It notes that Zoloft is ceased “(didn’t take)”. She is prescribed Avanza.
On 16 September 2014, Dr Cranney records amongst other things that the applicant is continuing to see a “counsellor through work”.
On 9 February 2015, Dr Alumt Von Schwedler records that the applicant had bulimia a few years ago. He notes the applicant’s weight is 58kg. He also records that the applicant was “referred to a psychologist via work, stay away from work; lowest weight was 48 kg”. The reason for visit is anxiety disorder.
On 10 February 2015, Dr Cranney records that a person from the eating disorder clinic called to say they were seeing the applicant soon.
On 11 August 2015, Dr Cranney records that Lexapro has ceased. Her weight is recorded at 67.9kg.
On 22 May 2018, a record of the medical practice notes that the applicant last visited in August 2015 but that the file was inactive and that the applicant lives in a different location.
The applicant returns to Dr Cranney on 7 December 2022, for a consultation in respect of a skin infection.
On 22 December 2022, Dr Cranney provides a diagnosis of anxiety/depression, rash and marriage difficulty. Dr Cranney prescribes Fluoxetine.
On 16 March 2023, Dr Cranney records that the applicant attends for anxiety/depression.
On 4 May 2023, Dr Cranney records the applicant has a “new partner”. He also records that she attends for anxiety/depression.
On 21 June 2023 and 5 July 2023, Dr Cranney records the applicant attends for anxiety/depression and other matters.
On 29 August 2023, Dr Cranney records that the applicant attends for anxiety/depression and also right knee issues (which arises from a rugby union injury earlier that month). By 5 September 2023, Dr Cranney records that the applicant has returned back to light training, running and rugby.
On 28 September 2023, Dr Cranney records “counselling-pt has through work” and “request restart fluox”. The reason for visit is recorded as anxiety/depression. She is given a prescription for Fluoxetine.
On 14 February 2024, Dr Cranney records the reason for visit as anxiety/depression and also marriage difficulty. He notes the applicant attends with her child, notes counselling and “r/v another time on own”.
On 15 February 2024, Dr Cranney records the applicant again attends with her child. He notes “r/v poor sleep, marriage difficulty.” He notes the applicant has had different medication over many years with different general practitioners. He records specific details of the share care arrangements with ex-partner in respect of the applicant’s child. He also records “court case family court 29.2.24”. The reason for visit is anxiety/depression, insomnia and “stress re upcoming family law court”. Her weight is recorded at 63kg.
On 21 February 2024, Dr Cranney records a reason for attendance to be anxiety/depression.
On 20 March 2024, Dr Cranney records a reason for visit “Wc stress/anxiety”. He records:
“requests WC cert as requested by work.
Served with avos from ex partner through Wyong Police station
so pt taking time off work as w/c as pt told to do this – works at Cesnock station
[child] … shared care with childs father --- presently family court proceedings apparently ex-partner … ex-police force 5 yrs – has new partner…”
In a WorkCover NSW – certificate of capacity dated 20 March 2024, Dr Cranney records a diagnosis of “stress/anxiety” with a date of injury of 16 March 2024. It records that the injury relates to work because “[h]as outstanding AVOrder against her. Anxiety returning to work.” The applicant is certified as having no current work capacity for the period 18 March 2024 to
21 April 2024.
On 10 April 2024, Dr Cranney records reason for visit:
“Anxiety/Depression
Ex Partner issues
Wc stress/anxiety
PTSD
Mental health care plan”
Dr Cranney notes:
“family law court – ongoing – over care [of child]
and
also
another court case as ex made avo against pt
pts dad also existing avo to stay way from ex
on 1.5.24 psychiatrist through – insurance-
psychologist –this Friday-----needs MHCPLAn as wc being reviewed. – previous MHCPLAN ----Dr AVS
working 13 yrs police force
wc knee injury
previously counselling through police –EAP—employers assistance program—struugling with work—last 4 to 5 yrs ago---in first 6w of work in 2011—pulled deceased badly burnt 7 yr old out of caravan—issues since,,not seen counsellor then” (as per original)
The applicant continues to attend on the medical practice for anxiety/depression on 15 and
17 April 2024 and on 2 May 2024 for anxiety/depression and post-traumatic stress disorder.
The last entry, on 22 May 2024, Dr Cranney records that the applicant attends for anxiety/depression and “ex Partner issues”. He records:
“requests further cert
Apparently s/b insurance psychiatrist ---“not wc”
…”
On 14 January 2025, Dr Cranney provides a letter to the applicant’s solicitor. The letter details the clinical history of the applicant relating to her weight issues. He notes that:
“More recently [the applicant] has brought up events from her work dating back to 2011 and the years following. She was then a young Police Officer and attended several events involving significant trauma to children.
It is certainly likely that these events contributed to her fatigue, lethargy, poor sleep and severe eating disorder in 2012.
It is also likely that these events have been an underlying issue in her day to day work and social life, but she managed to keep working with the support of her family and colleagues.
Unfortunately more recently there have been significant upheavals both in her work and social life involving her [child] and her ex-partner, a former Police Officer and father of their [child].
My opinion is that [the applicant] has suffered from underlying post-traumatic stress as a result of her employment with the NSW Police Force and is a substantial factor in her inability to presently continue work as a Police Officer.
However the final precipitating factor in this underlying stress causing her inability to continue work as a Police Officer was the very emotional and complicated entwined events with a former NSW Police Officer, the father of their [child].”

Ms Howell

In evidence are a series of records from the applicant’s treating psychologist, with whom the applicant attended on from 12 April 2024.
Ms Howell provides a series of handwritten notes from consultations with the applicant. The notes have been reviewed and some entries are extracted below:
(a)    On 12 April 2024, Ms Howell completes a clinical assessment form. Under the heading “Educational/Occupational problems” she records the applicant was a police officer of 13 years. She notes severe anxiety. She latter records the applicant has been on antidepressants for some time for anxiety and depression. She records the applicant has nightmares at night. There is a note the applicant feels she has suffered depression and anxiety for a long time and that it impacts her parenting (short fuse and hypervigilant) and relationships. It also notes traumatic events of a 7 year old’s death in a caravan when she was 21 years old and recent “children off their mother for an AVO – children crying”. Under the heading “Therapy goals” it is recorded “Anxiety, which will help OCD and bulimia”.
(b)    On 19 April 2024, Ms Howell records the applicant is a bit overwhelmed after the last session. She notes symptoms of a skin condition and teeth clenching.
(c)    On 14 June 2024, Ms Howell records the applicant has night sweats and fighting dreams of “abduction, children – things happening”.
(d)    On 3 July 2024, Ms Howell records that the applicant’s ex-partner has an “AVO on her and her dad”. She notes that the “smell of wet ashtrays and B.O. – trigger response.”
(e)    On 20 August 2024, Ms Howell records the applicant’s “solicitors IME – agreed PTSD with major depression”. She notes the applicant had to discuss the incidents and “supportive of her eating disorder in 2^nd year at work”. It notes:
“Not good driving at present. Concentration and shaky. [Child’s] birthday last week. Charged in 2018 on her birthday 6 years later for intimidation – court next month – not guilty. She is feeling worried about Police coming to the door. Scared that someone will do something to the house. Extreme hypervigilance.
…
The Police medical officer saw her when she was severely underweight reported on her affected by work then.
Get copy of current report.”
(f)    On 6 September 2024, Ms Howell records the applicant is in court on 26 September. She notes that the applicant is applying for her “TPD” and notes her last day of work was in March. It also notes that she has a “couple of days better but then waves happening and constant state of fear.”
(g)    On 27 September 2024, Ms Howell records that the appointment with the applicant was cancelled at short notice. Ms Howell records that there was a “court case yesterday & devastated by what has been written on social media”.
(h)    On 15 October 2024, Ms Howell records “Family court – charged for damages next year”. She notes that the applicant has another stress related rash over her body.
(i)    On 27 November 2024, Mr Howell records a reference to family court proceedings and that the applicant’s legal case is over and “March next year AVO on her”.
(j)    On 15 January 2025, Ms Howell refers to panic attacks, skin picking and scratching in sleep, wakes with nightmares of “accidents and losing [her child]”.

In a report to the applicant’s solicitors, undated, Ms Howell provides further comment on the applicant’s condition. Ms Howell notes that she read Dr Khan’s report, dated 30 July 2024, but that she did not have access to Dr MacDonald’s report at the time. Ms Howell states that she does not agree with the insurer’s decision.
Ms Howell states that the applicant had no previously recorded psychological injury prior to joining the respondent. She refers to the applicant’s early career in the police and notes that she faced a number of traumas which included children. She states that she agrees with Dr Khan’s opinion that it was surprising that the applicant was not assessed for post-traumatic stress disorder given she did not have a history of an eating disorder before commencing employment as a police officer.
Ms Howell refers to the symptoms of post-traumatic stress disorder and notes that the applicant ticks most of the DSMV criteria, and given these symptoms it would be “understandable that [the applicant’s] health, relationships and ability to cope at work would deteriorate and hence, lead to greater difficulties over time.” She states:
“In summary, my opinion is that [the applicant] has suffered a workplace injury that has been present since early days and yet not formally identified until more recent times. She requires ongoing treatment to deal with her symptoms both psychologically and pharmacologically. As PTSD is a chronic condition, [the applicant] will face an exacerbation of symptoms if placed within a similar employment role in the future, hence any future employment would be very restrictive due to her condition.”
Ms Howell provides a report to Unified Healthcare Group Pty Ltd, dated 22 February 2025.
Ms Howell records she has read the report of Dr MacDonald dated 4 May 2024. Ms Howell records she is not able to diagnose the applicant because she is a generalist psychologist but notes that the applicant displays symptoms consistent with DSM5 criteria of post-traumatic stress disorder with depression.
Ms Howell confirms that she had seen the applicant at least on 10 occasions from
12 April 2024. She notes that the applicant is undergoing CBT trauma therapy as a means to reduce her symptoms. She also notes that the applicant struggles emotionally and financially due to the insurer’s delay/non-acceptance of her claim.
In response to a question as to the reason the applicant has not had ongoing psychiatric care, Ms Howell states that the applicant is awaiting acceptance of her claim before she is able to gain psychiatric help.
In response to a question as to any known biopsychosocial factors impacting the applicant’s recovery, Ms Howell records that the applicant has had some issues with her past relationship but she considered that this was “now mostly settled and is separate and apart from the situation of PTSD/major depression incurred whilst working in the NSW Police Force.”
Ms Howell did not see the applicant returning to the employment with the respondent in either operational or non-operational duties, due to the possibility of re-traumatisation.

Dr Khan

Dr Abdal Khan, consultant psychiatrist, qualified by the applicant provides a report dated 30 July 2024. Dr Khan provides a report following an assessment via video conference.
Dr Khan records a history of the applicant’s employment with the respondent over 11 years. He records that the applicant was exposed to traumatic incidents including murders, suicides, fatal motor vehicle accidents, recovery of deceased persons, victims of assaults and sexual assaults. He also records that she was verbally and physically threatened by members of the public.
Dr Khan also records that the applicant first noticed her metal state to deteriorate within a few months of employment. Dr Khan refers to the caravan incident. He notes, consistent with the applicant’s statement, that her sleep became increasingly disturbed and she struggled with distressing memories and nightmares about the traumatic incidents. He further notes that the applicant’s appetite was also reduced and she lost weight, which was perpetuated by eating disordered behaviour that “served as a coping mechanism to deal with her traumatic exposures.”
Dr Khan refers to other traumatic incidents, including a DoCs retrieval case of two young children where there was a strong odor of cannabis and tobacco from an ashtray. He records the applicant has not been able to handle the smell of an ashtray since then. He also refers to traumatic incidents, including review of child pornographic material and an incident where a child committed suicide jumping from a cliff.
Dr Khan records:
“…she tried to continue to work and repress these aforementioned traumatic exposures but by mid-February 2024, she was unable to cope anymore. Although there were some personal stressors in early 2024, including related to her father facing a malicious damage offence and having an apprehended domestic violence order placed against him due to his actions against [the applicant’s] expartner, she maintained that these stressors were not the reason for her stopping work.
As a result of the protracted exposure to traumatic incidents during her employment, [the applicant] experienced gradual deterioration in her mental state characterised by nightmares, flashbacks and distressing memories about various traumatic incidents, physical and emotional symptoms of anxiety and panic, hypervigilance, heightened startle reaction, irritability, agitation, avoidance of trauma-related reminders including avoidance of her workplace, low mood, social withdrawal, reduced motivation, reduced energy, reduced enjoyment in activities, sleep disturbance with poor sleep maintenance and eating disordered behaviour (leading to weight loss exceeding 40kg since around 2012).”
Dr Khan refers to the clinical notes of Dr Cranney, notes her referral to a Police Medical Officer in relation to her mental health around 2014 and Dr Cranney’s communication from an eating disorder clinic. Dr Khan also notes that there was a period between 2015 and 2022 when the applicant seemed to have attended another general practice, but re-engaged in follow-up with Dr Cranney from 2022.
Dr Khan provides a detailed commentary on the applicant’s functioning and treatment history noting psychotropic medications. Dr Khan notes that the applicant’s mental state was stable prior to the subject injury. He records his findings on examination and provides a diagnosis of post-traumatic stress disorder, bulimia nervosa and alcohol use disorder. In response to a question about whether the applicant’s condition was caused or aggravated by employment,
Dr Khan states:
“[The applicant’s] condition was caused by the general nature and conditions of her employment as a police officer with the NSW Police Force as detailed in the ‘History of Presentation’ section of this report. In summary, she attended numerous traumatic incidents throughout the course of her employment, which have led her to suffer from pervasive symptoms of trauma, depression and anxiety as well as eating disordered behaviour and problematic alcohol use. The relevant period of employment has been [the applicant’s] entire employment with the NSW Police Force.”
Dr Khan states that the applicant’s employment with the respondent was the main contributing factor to the contraction of her disease. In response to details regarding the insurer’s declinature of liability and Dr MacDonald’s report, Dr Khan states:
“The opinion of the insurer as documented in the Section 78 Notice dated 17 May 2024 was noted. [The applicant] had certainly dealt with recent personal stressors pertaining to her ex-partner, her father committing a malicious damage offence upon her ex-partner and her father subsequently being served with an apprehended domestic violence order. While these circumstances caused [the applicant] some emotional distress, it is my opinion that her psychiatric/psychological injury has developed due to the nature and conditions of her employment as a police officer with the NSW Police Force. Her condition first manifested around 2012, as evidenced by the contemporaneous medical records from her treating general practitioner, Dr Cranney. It is my opinion that in trying to cope with the protracted exposure to traumatic incidents in the workplace, [the applicant] repressed these traumas rather than addressing their impact on her mental state directly and her condition at the time manifested overtly as an eating disorder despite her experiencing symptoms of intrusion, avoidance, negativity and hyperarousal. Over time, she had tried to mask her mental health difficulties but her colleagues and supervisors became increasingly concerned about her and she was formally referred to the police medical officer in 2014. It is surprising that she was not formally assessed for the psychiatric condition of post-traumatic stress disorder at the time given that she did not have a history of an eating disorder before commencing her employment as a police officer with the NSW Police Force. I do not agree with Dr MacDonald’s opinion regarding causation. I am of the opinion that [the applicant’s] employment as a police officer with the NSW Police Force was the substantial contributing factor to her psychiatric/psychological injury. I do not consider the personal stressors that occurred in early 2024 to be the substantial contributing factor to her current psychiatric/psychological condition. Ultimately determining [the applicant’s] entitlements to weekly compensation is a legal matter and not a medical matter. From a psychiatric perspective, I am of the opinion that [the applicant’s] need for reasonably necessary mental health treatment is causally related to her workplace psychiatric/psychological injury.”
Dr Khan states that the applicant requires ongoing treatment and that the treatment to date had been reasonably necessary for management of her psychiatric conditions. Dr Khan also states that the applicant is not fit for work and is totally incapacitated for reason of her psychiatric injury.
Dr Khan said that the applicant’s condition had not stabilised for the purposes of a permanent impairment assessment.

Dr MacDonald

Dr Kirsty MacDonald, forensic and general psychiatrist, qualified by the respondent provides a report dated 4 May 2024. Dr MacDonald provides a report following an assessment conducted via video conference.
Dr MacDonald provides a detailed background of the applicant’s working history, refers to the P902 Incident Notification and the Family Court proceedings and ADVO matter involving the applicant’s ex-partner. She states that the applicant attended Court in late February and early March 2024 in respect of these proceedings, but became incapacitated for work and ceased work in March 2024 after being served with an ADVO on 15 March 2024.
Dr MacDonald also provides a detailed history of traumatic events the applicant was exposed to during her police work. She refers to an event where the applicant attended a caravan fire where a seven year old was burnt to death and that she is triggered by caravans. She refers to another event relating to the DoCS removal of two young children, and notes the applicant went out drinking with colleagues that night because it was so awful. She also refers to an event where a young man she was talking to at a hospital later committed suicide and she saw “brain matter everywhere”.
Dr MacDonald records the applicant’s symptoms, to include nightmares which were primarily related to children, low mood, quick to anger, and currently drinking three to six glasses of wine at night.
Dr MacDonald notes that the applicant was diagnosed with depression, anxiety and an eating disorder when she was in her early twenties and was prescribed Fluoxetine.
Dr MacDonald stated that the applicant displayed a number of mood symptoms suggestive of a depressive disorder with features of anxiety and symptoms of trauma. Dr MacDonald added that:
“Of note, there appeared to be severe minimisation of the court and legal matters that precipitated her time off work and these were only briefly mentioned during the review. However, it is reasonable to assume that these had a much bigger effect given they were the direct precipitant to her having time off work, especially in the absence of other reported symptoms of her difficulties to deal with the traumatic events previously. [The applicant] is currently not working and receiving psychological treatment. She was previously diagnosed with depressive and anxiety conditions and has been taking antidepressant medication for over 12 months now.”
Dr MacDonald diagnoses the applicant with major depressive disorder with anxious distress. She also adds that the applicant “also described a number of traumatic symptoms although they do not qualify for a diagnosis of a traumatic disorder at present.”

In response to the following question, Dr MacDonald comments on causation:
“Do you consider that the current psychiatric condition is due to her issues and/or relationship breakdown with her ex-partner and the consequential events including the Family Court proceedings and an ADVO related court proceedings involving her ex-partner. In this regards we ask you to please take into consideration the above detailed history including that she had attended Court in late February and early March 2024 in respect of these proceedings and that she became incapacitated for work on 20 March 2024 after being served with an ADVO on 15 March 2024 by the Tuggerah Lakes Police and later being requested by Inspector White by text message of 22 March 2024 to be interviewed by the NSWPF in regard to the complaints/allegations against her.
Although [the applicant] described a number of traumatic incidents that she had attended as part of her work with the police force, the direct precipitant to her requiring time off work were the family court and AVO proceedings involving her ex-partner and her father. Looking at a timeline, given [the applicant] became incapacitated directly after attending court in February/March 2024, it appears that this was the reasonable precipitant and link to her condition. I believe that she has suffered an exacerbation of her depressive and anxiety symptoms secondary to these court appearances. Additionally, [the applicant] might have suffered some traumatic symptoms due to the number of traumatic incidents she has attended as part of her work with the police force. However, I believe that these symptoms have worsened in the context of her depressive illness worsening and I believe her depressive illness has worsened directly due to the court matters that she has been required to attend.”
Dr MacDonald considered that the applicant’s personal stressors “including the family court proceedings, the DVO matters and her father’s court proceedings are the predominant cause of the injury.” She notes that the applicant has been on antidepressant medications intermittently for the previous 10 years and had seen “multiple psychologists” for treatment of her conditions. Dr MacDonald considered the disclosure of the applicant’s “traumatic symptoms” appeared to be “a new phenomenon and require assertive treatment.” She did not consider the applicant was able to return to work and her conditions needed treatment, which to date had been reasonably necessary.
Dr MacDonald noted that the applicant displayed some symptoms of trauma but that this did not qualify for a diagnosis of post-traumatic stress disorder “at this point” and that “[o]ne-off assessments do not always give a full clinical picture of the disability suffered by individuals.” She added that the applicant’s case was complex due to her pre-existing illnesses, current stressors and conflating of these issues in both trauma and depressive symptoms which appear to have different genesis.

P902 Incident Reporting Form

In evidence is a NSW Police Force Incident Reporting Form – P902, dated 26 March 2024. It records a psychological injury in the nature of “Bullying & Harassment – by a peer / co-worker”, which was reported on 19 March 2024. The incident is recorded to have occurred on a basis of:
“Ongoing harassment from a former NSW Police Officer from Brisbane Water PAC, who is also my ex, has triggered an investigation by Professional Standards which exacerbated unreported MH concerns regarding exposure to many hazardous incidents in my early career. I have notified Cessnock Police Station at 17:30 on Sat 16 March 2024 and saw my GP on 19 March report a psychological injury.”

SUBMISSIONS

The applicant and respondent provided oral submissions during the hearing which were recorded. Those submissions will not be repeated in full but have been considered and will be referred to where relevant.

Applicant’s submissions

The applicant refers in detail to her statement evidence. The applicant refers to the traumatic events she encountered in her early career as a police officer. The applicant submits that these events were not reported as particular problems or under a formal form because of the culture of being a police officer, where officers tend to resort to talking about these matters with peers and consuming some alcohol. The applicant submits that she did not undertake any particular medical attention earlier, apart from some treatment with her general practitioner.
The applicant submits that absence of reporting of complaint does not mean that the events did not happen. There is no evidence that contradicts the applicant’s account in relation to the traumatic events as a police officer.
The applicant contends that there is a connection, as she asserts in her statement, between the development of her bulimia and her reaction to the event where she saw the incinerated child. The applicant refers to her statement evidence that she lost 12kg over a period of 6 to 12 months. The applicant submits that this is evidence of her anxiety and a “very early manifestation of symptoms of psychological injury” as a result of what she had been exposed to in the course of her service as a police officer.
The applicant notes that she sought assistance from Dr Cranney in 2012, and a reference is made to anxiety and weight loss. The applicant concedes there is no reference to the traumatic incidents but there does not need to be “some sort of perfect corroboration in the notes of a treating doctor to be satisfied that an event occurred and that in the worker’s estimation it was after that horrible event with the child occurred that the bulimia problems developed.” The applicant again refers to the culture of the Police Force that they did not “make a big deal about these things [referring to the traumatic events]”.
The applicant states her condition gradually got worse, after the event on Melbourne Cup day where a young boy committed suicide. The applicant refers to her symptoms of poor sleep, distressing memories, nightmares, waking bleeding from scratching her body, after this event.
The applicant refers to the traumatic events and submits that they form part of the clinical historical background. The applicant submits that these events have nothing to do with apprehended violence orders served on family members as a result of family disputes in 2021 which came to a head in early part of 2024.
The applicant refers to the evidence of Dr Cranney. These records indicate that the applicant was 63kg on 9 July 2012, 53kg on 26 October 2012 and advised to seek medical attention due to her weight loss. This provides a clinical corroboration of significant weight loss occurring after the applicant had been working as a police officer and that this follows on historically from the event of the burnt child.
The applicant notes that she moved around and did not see Dr Cranney again until December 2022. The applicant refers to Dr Cranney’s report in detail. The applicant submits that incapacities can result from multiple injuries and multiple conditions. The applicant relies on s 16 and submits that employment has to be the “major contributing factor”. The applicant submits that at the time she ceased work in March 2024 the family related matters were no doubt playing some part in her presentation and her problems. However, they were not the “major contributing factor, they were in the scheme of it all, we submit, relatively minor and one tests that in various way.” The applicant then submits that this can be tested by the actual diagnosis which is a post-traumatic stress disorder. The traumas that caused her nightmares, weight loss etc are to do with the earlier traumatic events and have “nothing to do with AVOs and disputes with partners”.

The applicant refers to evidence of Ms Howell, the treating psychologist. The applicant submits that Ms Howell is well aware of the argument that the respondent is making and decision to deny liability and states she does not agree with that decision. Ms Howell’s understanding of the referral and history is that it is the events spanning 13 years of police work which is relevant to the diagnosis of post-traumatic stress disorder. The applicant also submits that there were a number of consultations with Ms Howell, and she was in a good position to have been able to absorb the history and form an opinion. She discusses both the applicant’s personal situation and work traumas, and puts more emphasis on the latter. The applicant adds that Ms Howell was aware of the applicant’s personal problems because they are commented on in her notes, despite the factual history not being set out in her later report. The applicant further contends that there can be no suggestion that these details are being withheld from Ms Howell or that she was ignorant of them, as she has written down the details of those events. The applicant adds that even though the work trauma do not feature particularly in the handwritten entries she is aware of them because her reports talk at length about them.
The applicant submits that she has not been able to afford psychiatric treatment, and refers to Ms Howell’s evidence noting that she is awaiting acceptance of her claim before seeking psychiatric help. The applicant submits that her condition is a relatively serious and persistent condition which has been undertreated because psychiatric consultations have not been available to the applicant. The applicant submits that, on the balance of probabilities, the Commission would be satisfied that she has been totally incapacitated for work since March 2024 and remains incapacitated. The applicant contends that any residual work capacity described by Ms Howell is very minor and only available if the applicant is “completely in control of what she does” which is not found in paid work.
The applicant refers to Dr Khan’s evidence. The applicant submits that Dr Khan has a good appreciation of the history, which the applicant submits is evidence of fact and which is consistent with the applicant’s statement evidence. Dr Khan refers to the traumatic incidents and is aware of the later family problems. His opinion is premised on a good background and understanding of the factual and clinical matters. He notes that the applicant was referred to a police medical officer in 2014, but the applicant concedes that there is not much evidence about that but there is that history. He provides a well-reasoned opinion against the factual background. He has had the benefit of looking at Dr MacDonald’s reasoning. The applicant submits that he refers to important factual matters and that there is nothing recent about the symptoms of what he diagnoses as post-traumatic stress disorder. The applicant submits that she had these symptoms in the first year or so of being a police officer, and the first trauma caused her to lose a lot of weight in a relatively short period of time. This is not arising from events that occurred in 2024. The applicant submits that there does not need to be a:
“perfect documentary paper trail, you don’t need reports of injury form, you don’t need, you know, precise consultations with general practitioners that conveniently perfectly corroborate what might be written out in a form, you don’t sort of need then the immediate referral off to psychological professionals for treatment because someone suppresses them, when it’s almost like the culture of an organisation to talk about it with your colleagues and have a drink it’s perfectly understandable how what happened happened but these things eventually have a cumulative effect and the cumulative effect by 2024 was that she couldn’t work.”
The applicant refers to Dr Cranney’s certificate of capacity dated 18 March 2024, and submits that his opinion is more complex than the record saying “she’s unfit for work because of stuff associated with the apprehended violence order”. Dr Cranney recognises that this is a “final event but with causation in workers compensation, you know, there is no principle of proximate cause.” The applicant submits that what one looks at are factual matters that the Commission is satisfied occurred and the medical opinion that the causal chain of events leads to a particular situation. The applicant asserts that the related events are the trauma or the body’s failure to cope with the repeated stresses imposed on it, which applies to someone’s psyche as much as it applies to their physical symptoms. The applicant contends that there is the “body’s failure to cope with the repeated stresses imposed upon it and sometimes those are physical, here they’re mental and ultimately her psyche has been unable to cope with those repeated stresses and she’s become incapacitated”. The applicant submits that Dr MacDonald’s opinion that it is due to AVOs is something that cannot be accepted.
The applicant submits that Dr MacDonald leaps to the conclusion that there is a proximate cause rather than a more complicated history. Dr MacDonald is asked a leading question whether the cause is related to ADVO related events and is invited to provide a particular response. Her report starts off saying that the direct precipitant are these matters and then changes it to the predominant cause of the injury. The applicant submits that when you look at the “detailed history and things like bulimia…significant weight loss predating the ADVO stuff by more than a decade” it does not get factored into Dr MacDonald’s opinion. It fails to give proper weight to important historical matters. It does not endeavour to explain the applicant’s earlier symptoms or the traumatic nightmares.
Dr MacDonald’s opinion about the immediate precipitant is not the test. The test is what is the major contributing factor. It was the earlier horrendous traumas that the applicant’s psyche failed to cope with. It had the cumulative effect which brought the condition to light.
The applicant submits that she suffered psychological injury as a result of the traumatic experiences she experienced as a police officer and that as a result she is totally unfit for work. The applicant submits that Dr Khan’s opinion should be preferred over Dr MacDonald’s opinion.
The applicant made an application for an uplift for complexity at the maximum amount of 30%. The applicant submits that the matter had two hearing days, a lot of material with complexities, and time needed to deal with the matter.
Following clarification, the applicant modified her submission to seek reliance on s 15 of the 1987 Act and/or injury simpliciter and also s 16 of the 1987 Act. However, the applicant asserts that her primary submission is that s 16 can be applied referring to the repeated failure to cope with the stresses imposed on it. As a secondary submission and final fallback submission, the applicant submits, if it is not s 15 it is an injury simpliciter.

Respondent’s submissions

The respondent indicated that the only evidence it intended to refer to in any detail were the clinical notes of the general practitioner, Dr Cranney.
The respondent submits that the applicant’s case was presented as post-traumatic stress disorder acquired in the course of employment as a police officer, rather than an aggravation of a disease.
The respondent also submits that the relevant statutory test is whether employment was a substantial contributing factor to the contracting of a disease or the aggravation etcetera of a disease, not main contributing factor.
The respondent refers in detail to the clinical notes of Dr Cranney. The respondent submits that the first reference to any abnormal weight is on 4 August 2010, where it is recorded that the applicant gained excessive weight at the age of 17 but at the time of examination she was 65kg. The respondent notes that the applicant then joined the police force and on 9 July 2012 was recorded as weighing 63kg. On 26 October 2012 there is a note that the applicant lost 10kg of weight in the previous year and he diagnosed anxiety and bulimia nervosa.
The respondent submits that the applicant asserts that after her ultimate decompensation and departure from the police it was plainly evident to Dr Cranney that she had an underlying psychiatric condition as a result of police work over many years before. The respondent submits that Dr Cranney had regular clinical contact with the applicant. Dr Cranney prepared a mental health care plan in October 2012 but neither recorded any history of any difficulty experienced in the workplace or significant symptoms of the nature of post-traumatic stress disorder.
The respondent refers to Dr Cranney’s entry of 29 October 2012, where he institutes a mental health care plan. He notes issues with boyfriend, also a police officer, and records a referral to John Labone at KMC Axium. It is not known who Mr Labone is but the respondent submits it is either a counsellor or psychologist. The respondent submits that the plan appears to be instituted in the context of some interpersonal difficulties the applicant was experiencing.
Dr Cranney prescribed the applicant with Zoloft.
The respondent refers to the entry of 22 November 2012 which notes a follow-up regarding the referral for Axium psych.
The respondent refers to the entry on 8 September 2014, which records referral for tests for anorexia, fatigue and poor sleep. It also notes Zoloft was ceased which the respondent submits was for reasons unknown and unexplained, and suggests the applicant chose either not to fill or ingest the medication prescribed. The respondent also refers to the note that the applicant is continuing to see a counsellor through work. The respondent submits that it is not known what she told the counsellor but the inference is that she was not telling the counsellor that she was experiencing symptoms that she associated with work in 2014. The applicant is prescribed Avanza.
The respondent then refers to the entry on 9 February 2015, which records the applicant’s weight at 58kg. It notes that the applicant is described as having anxiety and is prescribed Lexapro. Lexapro was ceased on 11 August 2015.
The entry of 7 December 2022 records that the applicant had anxiety, depression, rash and marriage difficulty. She was prescribed Fluoxetine and there was a discussion about anxiety and depression in March 2023. The respondent then refers to several other entries in 2023 regarding attendance for anxiety and depression. The respondent then briefly refers to entries in early 2024 which references marriage difficulties, anxiety and poor sleep, and court proceedings. The respondent refers to the entry of 20 March 2024, after the deemed date of injury, where it is recorded workers compensation certificate requested by work and served with AVOs. The respondent submits that what appears to institute the workers compensation claim was the service of the AVO in the context of a dispute with the applicant’s former partner.
The respondent also refers to the P902 Form, dated 26 March 2024. It records psychological bullying and harassment by peer co-worker which is the applicant’s former partner.
The respondent submits that between the date of the applicant’s attendance on Dr Cranney on 20 March 2024 and the date of the P902 of 26 March 2024 the description of the presenting event has developed to include unreported mental health concerns.
The respondent concedes that the culture of the NSW Police Force results in serving police officers often reluctant to complain to their superiors where they are failing in some way in the job. The respondent submits that if that were the only matter to be considered that may constitute a very persuasive explanation as to why there is no record of the applicant’s earlier psychological response to workplace events. However, it does not explain why the applicant failed to inform her trusted general practitioner with whom she had been consulting since 2008. The respondent concedes that clinical reports may only provide a thumbnail sketch and do not constitute everything said in the consultation, but in the various consultations over the years there have been matters recorded of a personal nature and the applicant had confided in Dr Cranney about some elements of mental health concerns.
The respondent submits that Dr Cranney does not state that the applicant confided in him that she was experiencing psychological symptoms associated with her work experiences. Dr Cranney had no reason to believe, nor did he express one, that there was any relationship between the applicant’s bulimic symptoms and what was happening at work. The respondent submits as a general proposition that bulimia is a problem that emerges in the community but is not necessarily associated with traumatic events. Simply saying that, as the applicant states, she had distressing events at work and she had bulimia is “not enough to prove anything that would persuade” the Commission that there was an injury.
The respondent submits that there are opinions and clinical observations of Ms Howell, Dr Cranney and the independent medical experts. The respondent submits that the only person that had any insight into contemporaneous events was Dr Cranney. Ms Howell was engaged after the onset of this claim or notification of the incident, as were the independent medical experts. While Ms Howell saw the applicant on several occasions the only insight it gives is ex post facto, and more than 10 years after the traumatic events to which the applicant relies. However, Ms Howell provides some contemporaneous insight into what is happening in the applicant’s life at the time of the consultations.
The respondent refers to the hand written clinical notes of Ms Howell, from 12 April 2024. The respondent refers to entries regarding court proceedings which it submits do not bear any relationship with the applicant’s alleged injury. The respondent adds that the significance of the material is not apparent because the applicant has not given an explanation.
The respondent submits that Ms Howell is in no privileged position to give insight into events between 2012 and 2024 but is in the privileged position of recording matters of significance that had been reported since April 2024. The respondent notes that there is reference to historical workplace events and a reporting of the conflict involving litigation and family breakdown.
The respondent submits that the applicant has failed to say anything about the events of late 2023 and 2024 in her statement evidence, which saw her involved in AVO court proceedings, her father being restrained and other matters. It is not sufficient for the applicant to just say that her long term relationship broke down because of a lack of motivation and intimacy as a result of a work injury. The respondent submits that there is no basis to draw that conclusion.
The respondent contends that the applicant saw Dr Cranney on 20 March 2024 and she asked for a medical certificate because she was told she needed to get one because she had been served with an AVO. However, it was not until April, after the P902 was lodged, that there is the first mention in Dr Cranney’s notes that the event in 2011 where the applicant was exposed to the traumatic event at the caravan park.
The respondent does not submit that the traumatic events did not occur or were not distressing, but that it was not productive of the symptoms that warranted complaint to any medical practitioner or psychologist between 2011 and 2023. This, the respondent asserts, is the basis for Dr MacDonald’s opinion. The respondent accepts that traumatic events occurred but they are not what is productive of her current psychological disability, and, if they are, they are not a substantial contributing factor to it. The respondent submits that the applicant does not establish injury.

Applicant’s submissions in reply

The applicant submits that the Commission would be satisfied that employment was the main contributing factor, and, if the test is the lesser test (of substantial contributing factor) because the applicant is a police officer then it is easier to reach that conclusion.

RELEVANT LAW

Section 9 of the 1987 Act provides that a worker who has received an “injury” shall receive compensation from the worker’s employer in accordance with the 1987 Act.
Section 4(a) of the 1987 Act defines “injury” as a personal injury arising out of or in the course of employment. There is no compensation payable under s 4(a) of the 1987 Act unless employment is a “substantial contributing factor” to the injury, within the meaning of that phrase under s 9A of the 1987 Act. It is well established that the phrase “substantial contributing factor” involves a causal connection between the employment concerned and the injury.[2] The causal connection must be “real and of substance”.[3]
[2] Badawi v Nexon Asia Pacific Pty Limited t/as Commander Australia Pty Limited [2009] NSWCA 324, [80]-[83] (per Allsop P, Beazley and McColl JA); [112]-[117] (per Basten JA); [143] (per Handley AJA).
[3] Badawi v Nexon Asia Pacific Pty Limited t/as Commander Australia Pty Limited NSWCA 324.
In Rail Services Australia v Dimovski,[4] Handley JA stated that where a frank incident aggravated an underlying degenerative condition, it could properly be regarded as injury simpliciter within s 4(a) of the 1987 Act. To establish a personal injury (or “injury simpliciter”) there must be evidence of an identifiable pathological change.[5] That the change is connected to an underlying disease process does not prevent the event from being a personal injury.[6]
[4] [2004] NSWCA 267.
[5] Castro v State Transit Authority (NSW) [2000] NSWCC 12; 19 NSWCCR 496; Kennedy Cleaning Services Pty Ltd v Petkoska [2000] HCA 45; Military Rehabilitation and Compensation Commission v May [2016] HCA 19; Ky v Blue Leaf Food Group Pty Ltd [2016] NSWWCCPD 55.
[6] Zickar v MGH Plastic Industries Pty Ltd [1996] HCA 31; Rail Services Australia v Dimovski [2004] NSWCA 267.
Section 4(b) of the 1987 Act provides that “injury” includes a “disease injury”. Section 4(b)(i) provides that an injury includes a disease which is contracted by a worker in the course of employment and to which employment was a contributing factor. Section 4(b)(ii) provides that an injury includes the aggravation, acceleration, exacerbation or deterioration of any disease where employment was a contributing factor to that aggravation etc.
In determining the application of the disease provisions the Commission has routinely applied the four-step process set out in Austin v Director General of Education.[7] In that decision and applying Federal Broom Co Pty Ltd v Semlitch,[8] Clarke JA said the following questions should be asked:
“(a)    Was the applicant suffering from a disease?
(b)     If so, was there an aggravation, acceleration, exacerbation or deterioration of it?
(c)     If so, was her (his) employment a contributing factor?
(d)     If so, did a partial or total incapacity for work result from such aggravation, acceleration, exacerbation or deterioration?” [9]
[7] (1994) 10 NSWCCR 373.
[8] [1964] HCA 34; (1964) 110 CLR 626.
[9] (1994) 10 NSWCCR 373.
An aggravation of a disease under s 4(b)(ii) of the 1987 Act “occurs where the experience of the disease by the patient is increased or intensified by an increase or intensifying of symptoms”.[10] As Justice Windeyer said in Semlitch:
“[t]he question that each [aggravation; acceleration; exacerbation; deterioration] poses is, it seems to me, whether the disease has been made worse in the sense of more grave, more grievous or more serious in its effects upon the patient.”[11]
[10]Kelly v Western Institute NSW TAFE Commission [2010] NSWWCCPD 71, [66]; Federal Broom Co Pty Ltd v Semlitch [1954] HCA 34, [7] (per Windeyer J).
[11] Federal Broom Co Pty Ltd v Semlitch [1954] HCA 34, [9] (per Windeyer J).

As it is accepted that the applicant was and is a “police officer”, and her claim for compensation relates to her employment as a police officer, the amendments introduced by the Workers Compensation Legislation Amendment Act 2012 do not apply to the applicant. As a result, the applicant need not establish that the disease injury was “the main contributing factor” but rather that employment was a “substantial contributing factor” to the contraction of her injury or aggravation within the meaning of s 9A of the 1987 Act.
“Psychological injury” is defined in s 11A(3) of the 1987 Act:
“(3) A psychological injury is an injury (as defined in s 4) that is a psychological or psychiatric disorder. The term extends to include the physiological effect of such a disorder on the nervous system.”
The applicant bears the onus of proof, to establish her case on the balance of probabilities.[12] The relevant principles of onus of proof were discussed by Justice McDougall in Nguyen v Cosmopolitan Homes (NSW) Pty Ltd.[13] Justice McDougall said:
“A number of cases, of high authority, insist that for a tribunal of fact to be satisfied, on the balance of probabilities, of the existence of a fact, it must feel an actual persuasion of the existence of that fact. See Dixon J in Briginshaw v Briginshaw (1938) 60 CLR 336. His Honour’s statement was approved by the majority (Dixon, Evatt and McTiernan JJ) in Helton v Allen (1940) 63 CLR 691 at 712.”[14]
[12] Nguyen v Cosmopolitan Homes [2008] NSWCA 246, [44] (per McDougall J (McColl and Bell JJA agreeing)); Department of Education and Training v Ireland [2008] NSWWCCPD 134.
[13] [2008] NSWCA 246.
[14] Nguyen v Cosmopolitan Homes [2008] NSWCA 246, [44] (per McDougall J (McColl and Bell JJA agreeing)).

DISCUSSION

The applicant asserts that she suffers post-traumatic stress disorder as a result of her exposure to a series of traumatic incidents arising out of or in the course of her employment with the respondent and that her employment was a substantial contributing factor to the contraction and/or aggravation of the psychological injury. The applicant also asserts that she has total incapacity and requires ongoing medical treatment as a result of this injury.
The respondent does not dispute that the applicant suffers from a psychological condition or that she was exposed to a series of workplace traumatic incidents. The respondent also does not dispute the fact that the applicant has total incapacity for work and requires ongoing medical treatment for reason of her psychological condition. However, the respondent denies the applicant’s condition is due to an injury within the meaning of s 4 of the 1987 Act and/or that employment is a substantial contributing factor to the development of any psychological injury on the basis that the condition is caused by non-work factors.

Injury

The Commission has jurisdiction to determine injury and the nature of the injury. While it is preferable that a diagnosis be determined, it is not essential for that to occur before causation can be established and a finding is made on injury.[15] My task is to determine whether the applicant sustained an injury arising out of, or in the course of, her employment and whether that employment was a substantial contributing factor to the injury.
[15] AP v New South Wales Police Force [2013] NSWWCCPD 11, [243]; BFZ v Inner West Council [2024] NSWPIC 167, [11]-[26]; BOH v Engineering Solutions and Services Pty Ltd [2025] NSWPIC 34, [196]; Murray Goulburn Co-Op Co Ltd v Filliponi [2012] VSCA 230, [25].
The applicant clearly suffers from a recognisable psychiatric condition. However, the medical evidence differs on the actual diagnosis. Dr Khan provides a diagnosis of post-traumatic stress disorder, bulimia nervosa and alcohol use disorder. Dr MacDonald diagnoses the applicant with major depressive disorder with anxious distress, and notes traumatic symptoms which did not qualify for a diagnosis of post-traumatic stress disorder at the time of assessment. Ms Howell provides an opinion that the applicant displays symptoms consistent with the DSM5 criteria of post-traumatic stress disorder with depression, but qualifies her opinion stating that she is not able to provide a diagnosis as a generalist psychologist.
The difficulty in determining the cause of “injury” arises in-part because of the differing diagnoses. It is also because the applicant never made any complaint or sought any medical treatment in respect of the traumatic incidents, which she relies on as causative of her psychological condition, prior to the date of injury. There is no evidence prior to on or about early 2024 that records psychological symptoms, such as distressing memories, nightmares, hypervigilance related to the traumatic incidents. However, the fact that the applicant did not seek medical treatment or report her concerns does not mean she does not have a psychological injury or did not have a psychological illness prior to 2024.
For the reasons set out below, I accept the medical evidence supports that the applicant continues to suffer from an ongoing psychological condition in the nature of post-traumatic stress disorder. The psychological condition of post-traumatic stress disorder is caused by the applicant’s exposure to traumatic incidents at work. There are no other causes of the post-traumatic stress disorder (or the symptoms arising).
I have set out the details of the traumatic incidents in the evidence above. I do not propose to deal with them in any detail, given the respondent does not dispute the occurrence of those incidents. However, I will refer to them where relevant to the issues in dispute.

Report of complaint of traumatic incidents and symptoms

The applicant argued that the absence of contemporaneous complaint was due to the culture in the Police Force of not complaining about personal matters, and that while she experienced a psychological response to personal matters in 2024 they were not the cause of her post-traumatic stress disorder and related impairment. While the respondent contended that the applicant’s psychological condition related to non-work personal matters. This it argued was largely because there is an absence of contemporaneous complaint of the traumatic incidents or symptoms arising and there is a significant period of time between the initial incident and diagnosis of post-traumatic stress disorder.
I accept the respondent’s submission that from the attendance on Dr Cranney on
20 March 2024 and the date of the P902 Incident Reporting Form on 26 March 2024 the description of the presenting event developed to include other mental health concerns.
It is true the applicant attended on Dr Cranney on 20 March 2024 and he recorded the reason for attendance was for “Wc stress/anxiety” and the detail of that attendance focuses on personal matters relating to AVOs and family court proceedings. The Certificate of Capacity issued that same day records that the injury relates to work because the applicant has an outstanding AVO order against her and she had “anxiety returning to work”. It is not explained what that anxiety relates to as no one has addressed it, but I accept that these contemporaneous records do not refer to the traumatic incidents.
It is also true that the P902 Incident Reporting Form records the nature of injury as bulling and harassment by a peer co-worker and the details recorded in that document suggest that this co-worker is her ex-partner. It also records that there was an investigation instigated by the respondent’s Professional Standards which the applicant states exacerbated “unreported MH [mental health] concerns regarding exposure to many hazardous incidents” in the applicant’s early career. There is no evidence in respect to the Professional Standards investigation and how it relates to the traumatic incidents or what incidents.
I accept that there is a temporal connection between the applicant’s personal stressors relating to relationship issues, AVOs and family court proceedings, the date when the applicant initially took leave from work, and the date of injury. This is demonstrated by the clinical notes extracted above (from [45]). I have given this evidence close consideration. However, for the following reasons, I do not consider this fatal to the applicant’s case and this must be balanced against the totality of the evidence.
Firstly, I accept that notions of proximate cause or precipitating event in determining issues of causation, while relevant, is now no longer accepted law.[16]
[16] Kooragang Cement Pty Ltd v Bates (1994) 35 NSWLR 452, 463-364 (per Kirby P).
Secondly, it is true that there is a culture in the police force of a reluctance to report problems in the workplace and often officers will consume alcohol as a coping mechanism. The applicant stated this was the reason for not reporting and seeking treatment in respect of the traumatic incidents. The applicant stated that she was “too scared to speak up” and did not want to speak the truth in “fear of being outcasted”. She further stated that she was encouraged to use alcohol as a “coping mechanism” and did so. The respondent properly conceded that this culture is well known within the police force.
I am mindful that the applicant reported some interpersonal matters with treating general practitioners over the course of her employment with the respondent. However, I do not consider this was consistent or demonstrates that the failure to complain of the traumatic incidents in comparison is indicative of her not having a compensable injury. In this regard, I note that Dr Cranney records relationship difficulties with the applicant’s boyfriend in October 2012 around the time a mental health care plan was instituted but that this also coincides with treatment and referral to a dietitian in respect of her eating disorder. There are other references to relationship difficulties, in December 2022 in respect of marriage difficulty and in March 2024 where it is recorded disputes with the applicant’s ex-partner in the nature of an AVO. These single entries are relevant but do not demonstrate persistent personal relationship problems sufficient to warrant further clinical entries or record of any significant treatment in respect of those problems.
I accept the applicant’s evidence regarding her reason for failing to report and seek medical assistance for her symptoms arising from exposure to traumatic incidents, both within the workplace and with her treating general practitioner until 2024. It is supported by the evidence of Dr Khan who states the applicant masked or repressed her symptoms relating to the traumatic incidents.
Thirdly, the applicant stated that her mental state began to deteriorate within a few months of her employment with the respondent. She refers to the caravan traumatic incident and subsequent traumatic incidents. The applicant states that her sleep became increasingly disturbed and she struggled with distressing memories and nightmares of the workplace traumatic incidents. She states that she would wake in night sweats and bleeding from scratching her skin due to nightmares. She does not explain when these symptoms precisely arose or increased or whether she considered that she had a mental illness. However, she states she could no longer ignore the incidents by mid-February 2024. I accept this evidence.
Further, the applicant cannot be critcised for failing to report the cause of her symptoms (or the early deterioration of her mental state in the first few months of employment) as being exposure to the traumatic incidents. Indeed, the applicant need not identify or report as psychologically ill with symptoms of post-traumatic stress disorder for reason of her exposure to traumatic incidents before a finding of injury is made. That is because the true question is whether the applicant is suffering symptoms, which properly diagnosed, constitute an illness.[17] There may be a number of reasons why the cause of her psychological condition was not identified until more recently, including a focus on treating the physical effects of the eating disorder and more recently the recent stressors in the applicant’s personal life or due to masking the effects.
[17] Patrech v State of New South Wales [2009] NSWCA 118, [91].
Fourthly, the AVO and family court proceedings may have come to a head in early 2024 but no doubt would have been ongoing for several months if not years. It is understandable that in the wake of these matters being heard in court it would have brought about some stress and the applicant concedes that this affected her psychological state. These stressors may have coincided with the applicant’s symptoms arising from exposure to traumatic incidents and contributed to the applicant’s fragility but they are separate and distinct matters. Indeed, Dr MacDonald distinguishes between these symptoms noting symptoms of both depression, anxiety and trauma. She stated that these symptoms each appeared to have a different genesis. In respect of the applicant’s symptoms of trauma, Dr MacDonald accepted the applicant was exposed to workplace traumatic incidents and her reported symptoms which included nightmares. Dr Khan explains that the recent personal stressors caused emotional distress but he considered the traumatic events spanning the applicant’s career as a police officer were the cause of the post-traumatic stress disorder symptoms which initially manifested as an eating disorder. Ms Howell also stated that the applicant’s personal issues, which she considered had settled, were separate and apart from her symptoms of post-traumatic stress disorder and major depression.
Fifthly, it is true the applicant does not provide any detail regarding the non-work court proceedings in her statement evidence. However, she clearly reports these events to Dr Cranney, Ms Howell and both medico-legal experts. The histories reported and recorded by these medical experts are fairly consistent. Each medical practitioner has a history of the applicant’s medical and personal history, which includes her eating disorder, exposure to the accepted traumatic incidents and personal issues relating to AVOs and family court proceedings. It cannot be said that that history reported or recorded is incomplete.
Sixthly, a fair reading of Dr MacDonald’s opinion is that the applicant has both symptoms arising from the traumatic incidents and also the separate personal court proceedings. Dr MacDonald states that there “appeared to be a severe minimisation of the court and legal matters that precipitated [the applicant’s] time off work” which were only briefly mentioned, but she did not state that the applicant was untruthful. Indeed, she was of the view that the applicant did not qualify for a diagnosis of post-traumatic stress disorder “at this point” or “at present” but accepted she had traumatic symptoms which required “assertive treatment”.
Dr MacDonald may have provided an opinion that the non-work court proceedings were the direct precipitating event and/or the predominant cause of injury but this is not the relevant test. Further, this opinion must be read with Dr MacDonald’s comment of “severe minimisation” of the court proceedings and also the way in which questions of causation were asked. In this regard, I refer to [82] above.
To the extent the respondent relies on Dr MacDonald’s opinion as a basis to support a finding that the applicant has not sustained an injury, I make the following comments. It ignores Dr MacDonald’s opinion that the applicant had psychological symptoms arising from the traumatic incidents which required treatment. It further ignores Dr MacDonald’s view that her traumatic symptoms had “worsened in the context of [the applicant’s] depressive illness worsening…[which] has worsened directly due to the court matters that she has been required to attend”. These references support a finding of injury in the applicant’s favour.
I also observe that Dr MacDonald’s opinion, while well-reasoned, is affected by several matters. Her opinion fails to have adequate regard to the significance of the symptoms of post-traumatic stress disorder, including nightmares which had no bearing to the non-work court proceedings. It also fails to have regard to the fact that there may be multiple concurrent causes of a psychological condition which each may substantially contribute to psychological impairment. It further fails to comment on whether the applicant’s early clinical history of bulimia and psychological distress relates to the applicant’s exposure to traumatic events. These matters affect the weight to be attached to Dr MacDonald’s opinion.
Lastly, Dr Khan, Dr Cranney and Ms Howell provide opinions on causation supportive of the applicant’s case despite the lack of contemporaneous complaint of the traumatic incidents and symptoms. I address this evidence further below.

Early manifestation of symptoms

The applicant contended that there was a connection between her development of bulimia and reaction to traumatic incidents in the workplace. The applicant added that this was evidence of the applicant’s anxiety and an early manifestation of her symptoms of her psychological injury as a result of the exposure to the traumatic incidents. It is arguable that this is correct, but a finding in this regard is not necessarily determinative of there being an injury in the nature of post-traumatic stress disorder.
While I accept the applicant has the onus to discharge, I have not been assisted by the respondent’s submissions which have focused on clinical entries of the treating general practitioner with little regard to the medico-legal opinions. Those submissions makes several specific references to the applicant’s weight, medication prescribed, and non-work matters recorded in the clinical entries.
I accept that the symptoms and diagnosis of the applicant’s bulimia nervosa coincided with her exposure to the traumatic incident of the deceased child in the burnt caravan. It is true that the contemporaneous records of Dr Cranney first indicate that the applicant suffered from bulimia nervosa in October 2012 and that her weight had decreased by 10kg in the last year. This arguably identifies the commencement of those symptoms as early as October 2011, which coincides with the exposure to the caravan traumatic incident. However, I note that the applicant’s weight is recorded in August 2010 and July 2012 to be consistent and that the decrease in 10kg of weight appears to occur between July and October 2012 on the clinical records. The applicant’s weight then gradually increased by 15kg from September 2014 to August 2015. Thereafter, the clinical records do not appear to focus on these symptoms.
The contemporaneous medical evidence is silent on the cause of the applicant’s bulimia nervosa and relatively sparce on the reasons why she sought medical treatment for psychological symptoms which the general practitioner diagnosed as anxiety and depression. In this regard, there is no evidence:
(a)    of the details of the mental health care plan created by Dr Cranney in October 2012, although Dr Cranney notes at that time the applicant had difficulties with her then boyfriend (her ex-partner) and also was seeking treatment for her eating disorder;
(b)    from John Labone, of KMC Axium in respect of a referral for psychological treatment on or about October 2012;
(c)    from the treatment with a police counsellor on or about 2014, and
(d)    from the eating disorder clinic which the applicant attended on or about February 2015.
However, I accept as the applicant submits that there need not be perfect corroboration between the applicant’s account and contemporaneous medical evidence. There is no requirement for corroboration in a civil case.[18] Indeed, clinical notes rarely represent a complete record of exchange between the practitioner and patient or the complete clinical picture.[19] This general principle was properly conceded by the respondent.
[18] Chanaa v Zarour [2011] NSWCA 199, [86].
[19] Owen v Motor Accidents Authority (NSW) [2012] NSWSC 650, [52] (per Campbell J); Davis v Council of the City of Wagga Wagga [2004] NSWCA 34, [35]; Winter v NSW Police Force [2010] NSWCCPD 12, [183].

I also note that there is evidence that links the applicant’s eating disorder to exposure to the traumatic incidents. Dr Khan in July 2024, says that the applicant’s eating disordered behaviour served as a coping mechanism to deal with her exposure to traumatic incidents. He says that these incidents led to a weight loss exceeding 40kg since around 2012, but this is not consistent with the contemporaneous medical evidence and the applicant’s statement evidence which suggests the loss was only 10kg. Dr Khan expresses a view that the applicant’s psychological condition manifested in 2012 as an eating disorder and that she repressed the traumatic incidents rather than addressed them.
I consider that Dr Khan provided a fairly detailed opinion on causation against a background of the applicant’s factual and clinical history. His opinion may not specifically deal with each of the traumatic incidents or the personal matters in significant detail, but I am satisfied that he was sufficiently aware of them and his opinion was based on a fair history. Notwithstanding some imperfections noted above, I accept that Dr Khan’s opinion was both logical and probative.
Contrary to the respondent’s submissions, Dr Cranney provided an opinion of the cause of the applicant’s bulimic symptoms. Dr Cranney in January 2025 provides a report in which he says the applicant was exposed to several events involving significant trauma to children. He notes that these events were “brought up” more recently and date back to 2011 and the years that follow while the applicant was a police officer. He then expressed an opinion that is “certainly likely” that these events (or traumatic incidents) “contributed to her fatigue, lethargy, poor sleep and severe eating disorder in 2012”. Dr Cranney considered that the traumatic incidents (or events) were an underlying issue but that the applicant managed to continue working. He does not explain why this opinion was not drawn earlier in time and this affects the weight to be attached to that opinion. However, as the respondent submits, Dr Cranney is the only person that had any insight into contemporaneous events. This no doubt would include a full suite of her personal clinical records and picture. With that insight in mind, Dr Cranney’s opinion in his report of January 2025 provides compelling evidence on causation and is supportive of the applicant’s case of an early manifestation of psychological symptoms in 2012.
I accept that Ms Howell was well placed to provide an opinion on the applicant’s symptoms and cause having an awareness of the complete clinical picture, which included the non-work related court proceedings. Ms Howell saw the applicant approximately 10 times post March 2024. She records symptoms and complaints regarding the traumatic incidents and non-work court proceedings. In her subsequent report, she agrees with Dr Khan’s opinion that it was surprising the applicant had not been assessed for post-traumatic stress disorder earlier given she did not have an eating disorder prior to commencement of her employment with the respondent. Although, there is no further evaluation on causation.
Dr MacDonald’s evidence does not assist. Dr MacDonald does not address the cause of the applicant’s undisputed bulimia nervosa diagnosis or her other earlier symptoms of fatigue and poor sleep.
Having regard to the totality of the evidence, I accept that the medical evidence provides support for a connection between the applicant’s eating disorder and her exposure to traumatic incidents at work.

Contribution to employment and injury

It is true that exposure to traumatic incidents may trigger a psychological reaction which can result for some in a multitude of symptoms and effects, and for others nothing at all. In the present case there is evidence of a psychological reaction as early as October 2012, diagnosed as anxiety and bulimia nervosa for which the applicant was prescribed antidepressant medication. The cause of that reaction is less clear but I am satisfied that these symptoms in 2012 represent an early manifestation of her post-traumatic stress disorder which is not diagnosed until 10 years later. Even if I am wrong, and notwithstanding an absence of contemporaneous corroborative evidence (which I accept is not necessary),[20] I find that the applicant suffers from symptoms which persist and are consistent with a diagnosis of post-traumatic stress disorder. I am satisfied that the symptoms of the applicant’s post-traumatic stress disorder arose in the course of her employment through exposure to traumatic incidents as a police officer with the respondent.
[20] Chanaa v Zarour [2011] NSWCA 199, [86].
I do not accept the respondent’s submission that the applicant’s report of symptoms of post-traumatic stress disorder were not productive of her “current psychological disability”. It is not disputed that the applicant’s psychological condition was influenced by recent court proceedings. The applicant concedes that the court proceedings played a part in her presentation and psychological symptoms. However, the applicant’s post-traumatic stress disorder and associated symptoms did not originate from these non-work events rather they were caused by her exposure to traumatic incidents in the course of her employment with the respondent. The medical evidence does not provide any other cause of her post-traumatic stress disorder symptoms.
In view of the evidence relating to the family court proceedings which is contemporaneous to the date of injury and absence of evidence relating to the psychological treatment arranged by Dr Cranney and the respondent in 2014 and the eating disorder clinic, I have exercised caution when assessing the applicant’s evidence as a whole.
The connection between the applicant’s post-traumatic stress disorder and employment may be tenuous for reason of the lack of contemporaneous evidence. However, having regard to the totality of the evidence I accept the applicant’s evidence of the reason for non-reporting and the medical opinions on causation supportive of a workplace injury. This, together with the fact that the effects of exposure to traumatic incidents can become increasingly disabling with time and my acceptance of the medical opinions on causation, demonstrates that the applicant’s exposure to the traumatic incidents arose in the course of employment and that employment was a contributing factor to the contraction of post-traumatic stress disorder.
Findings of injury in the primary sense and pursuant to the “disease” provisions are not mutually exclusive.[21] A recognised psychological condition such as major depression or post-traumatic stress disorder is generally considered a disease injury.[22] But whether “a psychological condition is classified as an injury or a disease depends on the evidence in each case”.[23]
[21] Ky v Blue Leaf Food Group Pty Ltd [2016] NSWWCCPD 55, [72]; Inman v NSW Police Force [2013] NSWWCCPD 11, [249].
[22] Inman v NSW Police Force [2013] NSWWCCPD 11, [264].
[23] NSW Police Force v Gurnhill [2014] NSWWCCPD 12, [72].
It is understandable why the applicant sought to rely on the disease provisions as her primary submission on injury. The evidence does not clearly support a sudden and ascertainable or dramatic physiological change to establish a finding of injury under s 4(a) of the 1987 Act.[24] Indeed, it is unclear how the pleaded injury could constitute an injury simpliciter as the applicant’s submissions were undeveloped. The applicant did not precisely identify any specific event or physiological change which it relied on to satisfy s 4(a) injury, or the circumstance that was said to have aggravated or exacerbated etc the disease or how the injury simpliciter consisted in the aggravation of a disease. In the absence of submissions dealing specifically with these matters and having regard to the evidence, I am unable to find the applicant has established injury or injury simpliciter under s 4(a) of the 1987 Act. As a result, I do not propose to deal with whether employment in this regard was a substantial contributing factor under s 9A of the 1987 Act.
[24] Military Rehabilitation and Compensation Commission v May [2016] HCA 19, [47]-[48] (per French CJ, Kiefel, Nettle and Gordon JJ).
I accept that there is evidence that supports the applicant’s psychological condition is a disease or potentially an aggravation etc of a disease and employment was a contributing factor. However, it is unclear how the applicant’s psychological injury consists in the aggravation, acceleration, exacerbation or deterioration of any disease, within the meaning of s 4(b)(ii) of the 1987 Act. It was not explained how employment was said to have aggravated etc the applicant’s disease condition although I accept the applicant sought to assert that her symptoms gradually became worse after the suicide traumatic incident in 2021. The applicant then refers to some psychological effects on her psyche, but did not take me to any of the specific medical evidence in support and there is a gap in the clinical records between 2018 and December 2022 because the applicant had temporarily relocated and her medical file with Dr Cranney was inactive. While there is evidence that the applicant’s psychological condition may have been aggravated or deteriorated or that her psychological symptoms may have increased on or about early 2024, the applicant did not specifically address how the employment contributed to that aggravation or deterioration or increase in symptoms. In the absence of clear submissions, I am unable to find injury under s 4(b)(ii).
However, I am satisfied that the applicant has suffered a disease injury in the course of her employment to which employment was a contributing factor under s 4(b)(i) of the 1987 Act. Her symptoms of post-traumatic stress disorder including nightmares, distressing memories and hypervigilance, described in her statement evidence and consistently reported in the histories recorded by Ms Howell, Dr Khan and Dr MacDonald arose from the traumatic incidents in the workplace.
I prefer Dr Khan’s opinion which is supported by Dr Cranney and Ms Howell, over Dr MacDonald’s opinion. I also consider that Dr MacDonald’s opinion is supportive in some respects to the applicant’s case, for the reasons discussed above. While these opinions on the causation of the applicant’s post-traumatic stress disorder come after the applicant takes leave for reason of her injury, I accept the applicant’s evidence and submissions that the traumatic incidents had a cumulative effect and by early 2024 the applicant was no longer able to work.
A commonsense evaluation of evidence and the causal chain demonstrates that the applicant failed to cope with the repeated stress imposed on her for reason of the exposure to traumatic incidents and this manifested in both physical and psychological symptoms.[25]
[25] Fletcher International Exports Pty Limited v Barrow [2007] NSWCA 244, [61] (per Mason P).
It follows that employment contributed to the contraction of the applicant’s disease condition.

Section 9A

Having found the applicant’s employment was a contributing factor to her injury of post-traumatic stress disorder under s 4(b) of the 1987 Act, I now turn my attention to the application of s 9A(2) of the 1987 Act. Section 9A(2) of the 1987 Act provides a framework of matters to consider in determining the question of substantial contributing factor. The list is not exhaustive but provides examples of matters to be considered.
I have not been assisted by either counsel in addressing the test of substantial contributing factor, as neither addressed on the factors to be considered. While there may have been confusion as to the appropriate test to apply, the applicant conceded and agreed with the respondent that the test was whether employment was a “substantial contributing factor” to the injury. There also appeared to be acceptance that any reference to the test of “the main contributing factor” was not significant given that it poses a higher threshold test.
Turning to the matters in s 9A(2), I find:
(a)    The injury did not occur at any particular time or place. However, it is accepted that the applicant’s exposure to traumatic incidents occurred when she was performing work as a police officer. For reasons discussed above, I have found the applicant sustained post-traumatic stress disorder as a result of those traumatic incidents.
(b)    The nature of the work and tasks performed by the applicant is relevant and supportive of the traumatic incidents occurring at work. It is accepted that the applicant attended a series of traumatic incidents during the course of her employment from 2011. While the timeline of events is not entirely clear on the evidence, it is not disputed that the applicant was exposed to a workplace traumatic incident as early as 2011 and as late as 2021.
(c)    The applicant was a police officer from 2011, and it is accepted that she was exposed to a series of traumatic incidents in the course of her duties which were distressing. It is not disputed that the first of the series of traumatic incidents occurred within a few months of her employment.
(d)    There is evidence that indicates that the applicant had psychological symptoms the origin of which is non-work related. These non-work related events relate to relationship issues, AVOs and family court proceedings. The medical evidence distinguishes between the psychological effect of the traumatic incidents and non-work court proceedings. While these non-work related events are relevant, they are not productive of the diagnosis of post-traumatic stress disorder and associated symptoms having regard to the medical evidence.
(e)    The medical evidence indicates that the applicant was seeking treatment for symptoms arising from an eating disorder and anxiety/depression prior to 2024, which included counselling and antidepressant medication. There is no evidence to indicate the applicant experienced these symptoms or sought treatment for these symptoms prior to employment with the respondent and/or her exposure to traumatic incidents. I have also found that these symptoms are linked to an early manifestation of the applicant’s post-traumatic stress disorder. There are no known hereditary factors.
(f)    The applicant’s lifestyle and activities outside the workplace, are relevant in the context of the non-work related events. However, there are no lifestyle or activities that the parties indicated were relevant.
I accept that the applicant may have non-employment related substantial contributing factors to her psychological condition. The fact that the applicant may have psychological symptoms relating to AVO and family court proceedings does not mean she did not suffer a psychological injury for reason of her exposure to traumatic incidents. Employment only needs to be “a” substantial contributing factor to the applicant sustaining her psychological injury.[26] There may be multiple causes or competing substantial contributing factors, and it is a question of fact whether employment was a substantial contributing factor having regard to the totality of the evidence.[27]
[26] Department of Education & Training v Sinclair (2005) NSWCA 465.
[27] Badawi v Nexon Asia Pacific Pty Ltd [2009] NSWCA 324.
I am satisfied that the causal connection between the applicant’s employment and the development of her psychological injury in the form of post-traumatic stress disorder was “real and of substance”. It follows that I find that the applicant’s employment with the respondent was a substantial contributing factor to the psychological injury, pursuant to s 9A of the 1987 Act.

Incapacity

There was no dispute as to the applicant’s capacity to undertake employment. The respondent conceded that if I found for the applicant on injury she would be entitled to an award for weekly benefits for the period claimed. I accept the medical evidence supports the applicant was and continues to be totally incapacitated for the periods claimed, as a result of her psychological injury.
The parties agreed that the applicant’s probable earnings were $1,718.33 and the weekly wage rate was $1,607.27. There was also no dispute that her statutory rate should be adjusted for a single worker with one dependent child.

Medical expenses

The applicant has undertaken psychological treatment for her psychological condition, by her treating general practitioner and Ms Howell. There is no dispute on the evidence that the applicant needed this treatment and the medico-legal experts indicate that the applicant requires ongoing treatment for reason of her psychological symptoms relating to her exposure to traumatic incidents in the workplace.
It follows that there will be a general order for the reasonably necessary incurred medical expenses, pursuant to s 60 of the 1987 Act.

COSTS

The applicant is an exempt worker and as I have made findings in the applicant’s favour, there will be an award for costs against the respondent.
The applicant sought an order for an uplift in costs at the maximum amount of 30% for both parties, under cl 11 of Pt 1 of Sch 6 and Table 4 of Pt 2 of Sch 6 of the Workers Compensation Regulation. The respondent made no submissions in response.
I accept that this matter has some complexity having regard to the factual and medical evidence, but consider this is not unusual for psychological disputes and note the issues in dispute were fairly narrow. However, I accept that the matter has had a long procedural history, requiring two hearing dates and consideration of additional evidence for reasons set out above, which would have required additional preparation than a standard proceeding. Accordingly, in the exercise of my discretion, I certify the matter as complex and order an uplift of 20% for both parties’ costs.
The respondent is to pay the applicant’s costs as agreed or assessed.

DE-IDENTIFICATION

The decision contains significant details about sensitive medical and personal matters including relationship issues, family and criminal court proceedings. These matters relate to relevant persons involved in these proceedings, namely the applicant and her child.
I do not consider that the public interest in the administration of open justice outweighs the safety and wellbeing of relevant persons in these proceedings. To safeguard the safety and wellbeing of the applicant and her child, I consider it appropriate to depart from s 58 of the Personal Injury Commission Act 2020 supporting publication of decisions and the general principle of open justice.
Given the sensitive nature of the information contained within this decision, and having regard to the matters under r 132(4) of the Personal Injury Commission Rules 2021 (PIC Rules), I consider it appropriate to exercise my discretion to direct that the publishable decision be de-identified in-part.
I direct the publishable decision be de-identified in accordance with r 132 of the PIC Rules, to de-identify the applicant named in these proceedings.

CONCLUSION

The applicant has discharged her onus of proof that she suffered a psychological injury in the nature of post-traumatic stress disorder in the course of her employment and to which her employment was a substantial contributing factor.
The applicant had and continues to have no current work capacity and requires ongoing medical treatment for reason of her psychological condition. As a result, the applicant has an entitlement to the claimed weekly benefits and reasonably necessary incurred medical expenses.
I consider that there is a moderate level of complexity in this matter and grant an uplift in costs of 20% to both parties. Given the findings in favour of the applicant, an award for the applicant for costs will be made.
I also consider it appropriate that the applicant’s name is de-identified before the decision is published, pursuant to r 132 of the PIC Rules.

Accordingly, I make the orders set out above.

[2025] NSWPIC 371

1 August 2025