Hamilton v ERBD Pty Ltd - [2025] NSWPIC 454

CERTIFICATE OF DETERMINATION OF MEMBER
CITATION:	Hamilton v ERBD Pty Ltd [2025] NSWPIC 454
APPLICANT:	Noel Hamilton
RESPONDENT:	ERBD Pty Limited
MEMBER:	Karen Garner
DATE OF DECISION:	3 September 2025
CATCHWORDS:	WORKERS COMPENSATION - Workers Compensation Act 1987; claim for medical expenses pursuant to section 60 for surgery being L3/4 and L4/5 right sided decompression; applicant had accepted injury to lumbar spine; whether the surgery was reasonably necessary as a result of the accepted injury; Held – the surgery was reasonably necessary as a result of the accepted injury; the respondent to pay the applicant’s medical expenses in respect of the surgery pursuant to section 60.
DETERMINATIONS MADE:	The Personal Injury Commission determines: 1. Surgery, being L3/4 and L4/5 right sided decompression recommended by Mr Yanni Sergides, is reasonably necessary as a result of the injury pursuant to ss 59 and 60 of the Workers Compensation Act 1987 (the 1987 Act). The Personal Injury Commission orders: 2. The respondent to pay the costs of and incidental to L3/4 and L4/5 right sided decompression recommended by Mr Yanni Sergides pursuant to s 60 of the 1987 Act. A brief statement is attached setting out the Commission’s reasons for the determination.

STATEMENT OF REASONS

BACKGROUND

It is not in dispute that Noel Hamilton (the applicant), currently aged 59 years, sustained injury to his back (the injury) on 15 March 2022 in the course of his employment with ERBP Pty Limited (the respondent).
The applicant made a claim for medical and related expenses pursuant to s 60 of the Workers Compensation Act 1987 (the 1987 Act) in respect of L3/4 and L4/5 right sided decompression recommended by Mr Yanni Sergides (the surgery).
The respondent’s insurer denied liability for that claim on the ground that it disputed that the surgery is reasonably necessary as a result of the injury as required by s 60 of the 1987 Act.
The applicant also made claims for weekly compensation and expenses of hydrotherapy treatment in respect of the injury, which were also denied by the insurer.

PROCEDURE BEFORE THE PERSONAL INJURY COMMISSION

At a conciliation and arbitration hearing on 23 July 2025, the applicant was represented by Ms Kavita Balendra, counsel, instructed by Melinda Griffiths Lawyers. The respondent was represented by Mr Damien Toohey, counsel, instructed by Gair Legal.
At the hearing, the parties reached agreement to resolve the claims for weekly compensation and expenses of hydrotherapy treatment on terms recorded in a Certificate of Determination – Consent Orders issued by the Personal Injury Commission (the Commission) on
23 July 2025.
The hearing proceeded on the basis that the only remaining issue in dispute concerned the applicant’s claim for expenses pursuant to s 60 in relation to the surgery.
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…

Grounds of appeal

[14] The appellant contends that the primary judge erred in finding that the respondent had discharged the onus of establishing the matters required under the relevant provision.

[15] It was submitted that his Honour failed to give adequate weight to the evidence of the second witness, and that the findings of fact were not reasonably open on the material before the Court.

[16] The respondent, for its part, submits that no error is disclosed, and that the conclusions reached were well within the range of outcomes available to the primary judge.

Consideration

[17] It is convenient to deal first with the question of construction, as the resolution of that issue informs the remaining grounds advanced by the appellant.

[18] For the reasons that follow, we are of the view that the appeal should be allowed in part and the matter remitted for further determination.

Continue reading Hamilton v ERBD Pty Ltd

Details

AGLC: Hamilton v ERBD Pty Ltd [2025] NSWPIC 454
Case: [2025] NSWPIC 454
Decision Date: 3 September 2025

CaseChat Overview and Summary

The applicant in this matter, Hamilton, brought an action against ERBD Pty Ltd for payment of medical expenses under section 60 of the Workers Compensation Act 1987. The dispute centred around the necessity of a surgical procedure performed on the applicant's lumbar spine, specifically a right-sided decompression at levels L3/4 and L4/5. The applicant had previously acknowledged the injury to the lumbar spine, but the necessity and reasonableness of the surgical procedure were contested by the respondent. The matter was heard and determined in the relevant workers compensation tribunal.

The legal issues before the tribunal were whether the surgery in question was reasonably necessary as a consequence of the accepted injury and if it was, whether the applicant was entitled to compensation for the medical expenses under section 60. The tribunal had to consider the medical evidence presented regarding the need for the surgery, the nature of the injury, and the provisions of the Workers Compensation Act 1987.

After evaluating the evidence, the tribunal found that the surgery was indeed reasonably necessary as a result of the accepted injury. The medical evidence supported the conclusion that the decompression surgery was required to address the lumbar spine injury. Consequently, the tribunal ruled that the respondent was liable to pay the applicant's medical expenses for the surgery under section 60 of the Act. The tribunal's decision was based on the clear link between the accepted injury and the necessity of the surgical procedure.

The tribunal ordered ERBD Pty Ltd to pay the applicant's medical expenses for the lumbar spine surgery, in accordance with section 60 of the Workers Compensation Act 1987. This decision affirms the entitlement of the applicant to reimbursement for the surgery, recognising the necessity of the procedure as a direct consequence of the accepted injury.

Orders