Hull v Estia Health - [2025] NSWPIC 305

CERTIFICATE OF DETERMINATION OF MEMBER
CITATION:	Hull v Estia Health [2025] NSWPIC 305
APPLICANT:	Hull
RESPONDENT:	Estia Health
MEMBER:	Karen Garner
DATE OF DECISION:	1 July 2025
CATCHWORDS:	Workers Compensation Act 1987; claim for compensation for medical treatment pursuant to section 60; accepted work injury to cervical spine; applicant claimed compensation for cost of C5/6 and C6/7 anterior cervical discectomy and fusion surgery; whether the surgery was reasonably necessary as a result of the accepted injury; Held – C5/6 and C6/7 anterior cervical discectomy and fusion surgery is reasonably necessary treatment as a result of the accepted cervical spine injury; order that the respondent to pay the costs of and incidental to the surgery pursuant to section 60.
DETERMINATIONS MADE:	1. The C5/6 and C6/7 anterior cervical discectomy and fusion surgery proposed by Dr Rob Kuru is reasonably necessary medical or related treatment pursuant to s 60 of the Workers Compensation Act 1987 as a result of a cervical spine injury sustained by the applicant on 13 May 2023. 2. The respondent to pay the costs of and incidental to C5/6 and C6/7 anterior cervical discectomy and fusion surgery proposed by Dr Rob Kuru in accordance with s 60 of the Workers Compensation Act 1987.

STATEMENT OF REASONS

BACKGROUND

Rachael Ellen Hull (the applicant) is a 42-year-old woman.
It is not in dispute that, on 13 May 2023, in the course of her employment with Estia Health (the respondent) as an Assistant-in-Nursing, the applicant was assaulted by a nursing home resident which injured her cervical spine and left shoulder (the injury). The respondent accepted liability for the injury.
The applicant made a claim for medical and related expenses pursuant to s 60 the Workers Compensation Act 1987 (1987 Act) in respect of C5/6 and C6/7 anterior cervical discectomy and fusion surgery proposed by Dr Rob Kuru (the surgery).
The respondent’s insurer (the insurer) declined liability for the treatment on the basis that:
(a) the surgery is not reasonably necessary as a result of an injury as required by s 60 of the 1987 Act.

PROCEDURE BEFORE THE PERSONAL INJURY COMMISSION (COMMISSION)

The present proceedings were commenced by an Application to Resolve a Dispute (ARD) lodged in the Commission on 7 March 2025, seeking compensation pursuant to s 60 of the 1987 Act for and related to the surgery. The respondent lodged a Reply to the ARD (Reply) on 26 March 2025.
At a conciliation/arbitration hearing conducted by MS Teams on 4 June 2025, Mr Dewashish Adhikary, counsel, appeared on behalf of the applicant, instructed by Ms Rachael Abouchrouche of LHD Lawyers. Mr Daniel Stiles, counsel, appeared on behalf of the respondent, instructed by Ms Stephanie Dunn, solicitor of BBW Lawyers.
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.…

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.

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Details

Case: [2025] NSWPIC 305
Decision Date: 1 July 2025

CaseChat Overview and Summary

The case of Hull v Estia Health involved a dispute between the applicant, Hull, and the respondent, Estia Health, concerning compensation for medical treatment under the Workers Compensation Act 1987. Hull had suffered an accepted work-related injury to his cervical spine. He sought compensation for the cost of C5/6 and C6/7 anterior cervical discectomy and fusion surgery, claiming that this procedure was reasonably necessary due to his injury. Estia Health disputed the necessity of the surgery and the associated costs.

The legal issues before the court included whether the surgery in question was reasonably necessary as a result of Hull's accepted injury and whether he was entitled to compensation for the cost of the surgery under section 60 of the Workers Compensation Act 1987. The court had to determine whether the surgery was an appropriate and necessary response to the injury Hull sustained in the course of his employment.

The court found that the C5/6 and C6/7 anterior cervical discectomy and fusion surgery was reasonably necessary treatment resulting from Hull’s accepted cervical spine injury. The evidence presented supported that the surgery was required to address the injury and alleviate the symptoms Hull was experiencing. The court accepted the medical evidence and Hull's circumstances, concluding that the surgery was both necessary and reasonably required. Accordingly, the court ordered that Estia Health must pay the costs of and incidental to the surgery as required by section 60 of the Workers Compensation Act 1987.

Orders