Knott v Qantas Ground Services Pty Ltd

CERTIFICATE OF DETERMINATION OF MEMBER
CITATION:	Knott v Qantas Ground Services Pty Ltd [2025] NSWPIC 444
APPLICANT:	John Knott
RESPONDENT:	Qantas Ground Services Pty Ltd
MEMBER:	Josephine Bamber
DATE OF DECISION:	28 August 2025
CATCHWORDS:	WORKERS COMPENSATION - Workers Compensation Act 1987; claim for proposed hip replacement surgery in circumstances where applicant had asymptomatic osteoarthritis in the hip before the workplace injury; respondent disputes the surgery is reasonably necessary treatment as a result of the workplace injury and asserts the effects of the injury have ceased; Held – the effects of the injury have not ceased and finding made that the proposed hip replacement surgery is reasonably necessary treatment as a result of the workplace injury.
DETERMINATIONS MADE:	The Commission determines: 1. The effects of the work related injury on 29 February 2020 have not ceased. 2. The proposed left hip replacement surgery is reasonably necessary treatment as a result of the work related injury on 29 February 2020. 3. The respondent is to pay the costs of the proposed left hip replacement surgery and ancillary treatment at the SIRA gazetted rates. A brief statement is attached setting out the Commission’s reasons for the determination.

STATEMENT OF REASONS

BACKGROUND

John Knott, the applicant, was working as a baggage handler for the respondent, QANTAS Ground Services Pty Ltd when on 29 February 2020 he sustained an injury to his groin and hip region while unloading a container into a plane. His claim for compensation in these proceedings is confined to a total left hip replacement and related expenses claimed in his Application to Resolve a Dispute (ARD). The reference in the ARD to the “right” hip is a typographical error and the ARD is amended to delete that reference and replace it with “left”.
The respondent disputes liability under s 60 of the Workers Compensation Act 1987 that the claimed treatment is reasonably necessary treatment as a result of the workplace injury. It asserted in its dispute notice issued pursuant to s 78 of the Workplace Injury Management and Workers Compensation Act 1998 (the 1998 Act) dated 19 September 2022 that the injury the applicant sustained to his left hip on 29 February 2020 has resolved and any ongoing symptoms are as a result of pre-existing degenerative osteoarthritis. On
14 August 2023 the insurer confirmed their declinature.

PROCEDURE BEFORE THE PERSONAL INJURY COMMISSION

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.
As the matter could not be resolve it proceeded in arbitration hearing before me. Mr Bill Carney, counsel, instructed by Ms Medea Hanna, solicitor, appeared for Mr Knott, who was present. Mr John Gaitanis, counsel, instructed by Ms Lily Fung, solicitor, appeared for the respondent. Mr Bazley from the insurer appeared on the MS Teams platform.

EVIDENCE

Documentary evidence

The following documents were in evidence before the Personal Injury Commission (Commission) and considered in making this determination:
(a) Application to Resolve a Dispute and attached documents, and
(b) Reply and attached documents.

Oral evidence

There was no oral evidence. The parties made oral submissions which were sound recorded and a copy is available to the parties.

FINDINGS AND REASONS

“Injury” is not in issue. The respondent has placed in issue both limbs of s 60 of the 1987 Act. However, its counsel has fairly acknowledged that Dr Gray is of the opinion that the total left hip replacement is reasonably necessary treatment. The main issue is whether the proposed treatment results from the injury. Dr Gray is of the opinion that the effects of the injury have ceased and the need for the surgery is causally related to the pre-existing osteoarthritis in the left hip.
The legal test to be applied is stated by DP Roche in Murphy v Allity Management Services Pty Ltd[1] at [56]:
“Ms Murphy only has to establish, applying the commonsense test of causation (Kooragang Cement Pty Ltd v Bates (1994) 35 NSWLR 452; 10 NSWCCR 796), that the treatment is reasonably necessary ‘as a result of’ the injury (see Taxis Combined Services (Victoria) Pty Ltd v Schokman [2014] NSWWCCPD 18 at [40]– [55]). That is, she has to establish that the injury materially contributed to the need for the surgery (see the discussion on the test of causation in Sutherland Shire Council v Baltica General Insurance Co Ltd (1996) 12 NSWCCR 716).”
[1] [2015] NSWWCCPD 49 Murphy.
I have briefly summarised the main evidence before considering counsels’ submissions.

Summary of evidence

The applicant is now aged 59. He commenced employment as a baggage handler with the respondent in November 2015 and ceased employment in early February 2021. In his statement he says prior to his injury on 29 February 2020 he was in good health and he used to walk his dogs and surf recreationally.
He describes his workplace injury as involving rollers which were not working and he had to forcibly push the container onto a machine before it could be put into the plane. He says in the course of doing this he felt immense pain in his groin, but he was able to complete his shift. He states that the next morning he could hardly lift his left leg to get out of bed. He was not rostered on that day and he went to work the following day and reported the incident to his supervisor, who referred him to undergo physiotherapy sessions provided by the employer. He attended five sessions until they ceased due to Covid-19. QANTAS also referred him to a doctor for a telehealth consultation and he arranged an ultrasound to ascertain if he had a torn muscle or hernia, which were not detected.[2] He had an MRI scan on 27 May 2020 which did not reveal a hernia[3] and so the doctor referred him for an MRI of the left hip, which took place on 1 June 2020.[4]
[2] ARD p 45.
[3] ARD p 46.
[4] ARD p 47.
The applicant was treated by Dr Gerald Yuen, Sydney Airport Medical Centre, on
21 April 2020 who diagnosed soft tissue injury to the left groin due to the workplace injury.
[5] ARD p 26.
Dr Yuen in report dated 22 March 2024 stated that the osteoarthritis in the left hip was likely to have multiple contributing factors, one being employment. He says the total hip replacement surgery would significantly improve his symptoms and is necessary. He says he is not an expert to determine whether this is mainly from his workplace injuries.[5]
Dr Yuen referred the applicant to Dr Andrew McDonald, sports medicine specialist.
[6] ARD p 28.
[7] ARD p 48.
Dr McDonald reported on 29 June 2020 that he had examined the applicant and that his symptoms are due to left hip osteoarthritis.[6] At that stage the applicant wanted to trial conservative management and to avoid as long as possible a hip replacement. Dr McDonald referred to the MRI scan which showed decreased femoral head-neck offset and osteoarthritis with significant cartilage wear within the hip joint and there was mild lateral trochanteric syndrome. He stated that X-rays taken on 29 June 2020[7] showed essentially complete loss of superolateral joint space at the left hip and significant decrease in femoral head-neck offset bilaterally.
Geoffrey Colman, physiotherapist, reported on 16 September 2020 about the treatment given to the applicant.[8]
[8] ARD p 29.
Dr Solomon reported to Dr Yuen, Sydney Airport Medical, on 4 September 2020 that he saw the applicant that day about his ongoing left hip pain. He advises that the applicant had experienced some mild improvement with Mobic but still has ongoing discomfort and stiffness. He related that dog walking was getting harder. The doctor records the applicant was not getting any right hip pain and that hip had a good range of pain-free motion.
Dr Solomon found the left hip to be stiff and irritable with marked restricted movement. He says a pelvic X-ray confirmed an arthritic left hip and some early changes starting on the right.
Dr Solomon states that the applicant has established osteoarthritis in the left hip, which is long-standing but the injury on 29 February 2020 has aggravated his arthritis to the point where it has not become symptomatic on a daily basis. Prior to the injury he did not complain of hip pain. The doctor states that the only effective solution is for him to consider a total hip replacement if nonoperative therapies to improve pain symptoms are no longer effective. He states there is no point him having an injection into the hip joint. He advises that while the arthritis was pre-existing the injury resulted in him having ongoing discomfort in the left hip.
Dr Solomon in report dated 18 March 2021 addressed to the insurer and advises that both
Dr Gray and he agree that the applicant’s work injury aggravated a pre-existing condition.[9]
[9] ARD p 11.
Dr Solomon states that the real question is at what point did his work related injury cease to be an aggravation. He says this is an impossible question to answer. Dr Solomon adds that prior to his injury the applicant did not complain of any significant hip pain, however, his arthritis was well established. He states that following the injury he complained of pain and his pain has not ceased.
Dr Solomon concedes that at some point in the future, if the applicant did not have a work injury, he would develop pain and discomfort to the extent that he would require a total hip replacement. Dr Solomon says he cannot define when the aggravation from the work injury would cease but can only state that following the aggravation he became symptomatic and has remained symptomatic.
Dr Soo provided a medico-legal report for the applicant dated 8 February 2023.[10] The doctor sets out the applicant’s current symptoms such as ongoing pain which can radiate down the thigh to the lower leg. The constant pain is worse with bending or prolonged standing or walking. He has difficulty sleeping at night and the hip clicks regularly. The applicant was taking Mobic and self-directed exercises. He noted the applicant walked with a limp and had a positive Trendelenburg test to the left hip. Dr Soo’s diagnosis is aggravation of underlying advanced osteoarthritis to the left hip. He advises that the mechanism of injury of pushing a container with faulty wheels is consistent with the diagnosis and the findings on imaging. He finds that the work is a substantially contributing factor towards the aggravation of the underlying osteoarthritis of the left hip.
[10] ARD p 15.
Dr Soo is of the opinion that the proposed surgery of a left total hip replacement is reasonably necessary and as a result of the work injury on 29 February 2020. Dr Soo states that a long period of non-surgical measures has resulted in little improvement in his left hip or function. He says the only option is to live with the pain or have the surgery and the only surgery that will improve his function is a total hip replacement. He estimates the cost at $25,000 plus after ongoing physiotherapy and rehabilitation.
On 1 August 2023 Dr Soo provided a supplementary report.[11] The solicitors asked the doctor to consider whether the injury was the main contributing factor to the aggravation of the underlying arthritis. This is not the correct legal test in this matter. The injury comes within
[11] ARD p 21.
[12] [2004] NSW CA 267, Dimovski.
s 4(a) of the 1987 Act as discussed in many cases including Rail Services Australia v Dimovski.[12] Nothing turns upon this in the present case, as the insurer does not dispute that a left hip injury occurred.
The respondent engaged as an independent medical examiner, Dr Peter Gray, orthopaedic surgeon to advise them. He has issued reports dated 23 December 2020[13] and
29 December 2021.[14] In his first report he advised that in the work injury on
[13] Reply p 1.
[14] Reply p 14.
29 February 2020 the applicant sustained a significant strain injury to his left hip joint aggravating the previously present but asymptomatic osteoarthritis in the left hip. He says the pain and stiffness that the applicant experienced the day after the injury suggests the development of a traumatic effusion into the left hip joint as a consequence of the work injury. He says the ultrasound on 15 April 2020 confirmed a small hip joint effusion consistent with gradual resolution of the effusion over time. He opines that the irritability caused by the workplace injury has ceased and his current symptoms are consistent with the radiologically apparent osteoarthritis in his left hip.
He says the requirement for a hip replacement is based on the pre-existent asymptomatic but now symptomatic osteoarthritis in the left hip. He says the time to undertake a hip replacement is when the patient’s symptoms significantly interfere with their comfortable enjoyment of life. He says it is possible the applicant would have requested this surgery at this time in his life regardless of the workplace incident.
He says a similar incident could have occurred when undertaking normal day to day activities such as tripping over a dog lead causing pain in previously asymptomatic osteoarthritis in the hip. However, the insurer has agreed the applicant did sustain a hip injury. The fact that it aggravated asymptomatic changes in the hip places the injury under s 4(a) of the 1987 Act and the insurer has not put s 9A in issue. In any event, it is not relevant that he could have sustained the injury in other circumstances because the fact is he sustained it at work on
29 February 2020. Dr Gray states that the work-related irritability caused by the incident on 29 February 2020 has resolved and that “no portion of the prosed surgery is addressing the work-related mechanism of injury”.
Dr Gray finds that a total hip replacement is an extremely successful operation in the relief of pain secondary to osteoarthritis. He adds the extent to which hip pain cannot be relieved without a total hip replacement is testament to the surgery being necessary.
In his second report Dr Gray says in the absence of irritability in the left hip joint as opposed to stiffness his opinion is that the aggravation sustained in the work incident has ceased. He adds that the applicant is now significantly disabled by pain and restricted in his activities and the doctor believes it is reasonable to proceed with the total hip joint replacement.
Dr Vaibhav Punjabi wrote to Dr Syed Adil Zafar on 17 February 2025 noting that the applicant was on the waiting list for a left total hip replacement.[15] Dr Punjabi examined the applicant and advised that the applicant has noticed pain in both hips, left more than the right, for the last five years, which had worsened recently. He takes Mobic and Panadol Osteo. The doctor reports that the applicant’s hip clicks but does not lock and the leg occasionally gives way. He struggles with activities of daily living and is unable to surf. The doctor noted he walked with an antalgic gait and a Trendelenburg gait. The doctor says he discussed with the applicant non-operative treatment such as optimising analgesia, steroid injection and use of a walking stick. He says the surgical option is a total hip replacement. The applicant advised the doctor that the pain is affecting his quality of life and his mobility and he would like to undergo surgery.
[15] ARD p 24.

Determination

It is common ground that before the event of 29 February 2020 there is no evidence that the applicant suffered from any symptoms in his left hip. In his statement he states he had no such symptoms and he used to undertake surfing and walking his dogs without a problem. Furthermore, I note, he was able to work as a baggage handler since November 2015.
It is also common ground that the applicant had pre-existing osteoarthritic changes in the left hip as demonstrated on the X-rays and MRI scan. The pathology in the left hip was significant as there is a reference to bone on bone pathology in the left hip.
The respondent submits that the ultrasound, while not finding a hernia, did find there was a small effusion in the left hip joint. The respondent concedes that Dr Gray found that the work injury did aggravate the applicant’s pre-existing osteoarthritic condition in his left hip. However, that Dr Gray finds the work related “irritability” in the hip has ceased and the continuing symptoms and need for surgery relates to the underlying osteoarthritis in the hip.
The respondent submits that Dr Soo’s opinion is deficient because he does not articulate what is the aggravation from the work injury. I do not accept this criticism of Dr Soo’s opinion. He takes a careful history, in my view, and notes that the pain is constant and worse with bending or prolonged standing or walking, he has difficulty sleeping at night and the hip clicks regularly. I find it is apparent from his report that he is explaining that these ongoing symptoms are due to the underlying osteoarthritis in the hip being aggravated. He noted the applicant walked with a limp and had a positive Trendelenburg test to the left hip. Dr Soo’s diagnosis is aggravation of underlying advanced osteoarthritis to the left hip. Clearly the aggravation caused by the mechanism of injury on 29 February 2020 is the development of these symptoms.
The respondent submits that the applicant cannot discharge his onus of proof based on
Dr Solomon’s opinion because he says he cannot define when the aggravation from the work injury would cease.
The respondent submits that the question is to what extent can someone define when it is that the natural history of the arthritic hip still continues to be a problem. However, I reject this argument. I find when Dr Solomon’s reports are read as a whole, he is acknowledging the problem in diagnosis of the cause of ongoing symptoms but he then states that it is the fact that the applicant was asymptomatic before the injury, became symptomatic after the injury and that his symptoms have continued. I find this opinion of Dr Solomon does lend support for the finding that the injury has materially contributed to the need for surgery.
Clearly, a person with such significant pathology in his hip would have at some point in time in the future have become symptomatic but it is the case that it became symptomatic because of the heavy nature of his work task on 29 February 2020. I reject the opinion of
Dr Gray which suggests the injury was just effusion in the hip joint which has settled or “irritability” that has resolved. I find that Dr Gray has not taken sufficiently into account the unremitting nature of the symptoms the applicant has experienced. The injury made his asymptomatic hip symptomatic to the extent that since 29 February 2020 he has not been able to perform his usual domestic and recreational tasks to the same extent as he did before the injury. The injury has continued to interrupt his sleep. He has ongoing pain in the left hip as submitted by the applicant’s counsel. He also submitted that Dr Gray expresses the opinion that a reason to perform the surgery is to treat the pain and counsel submits the applicant has suffered the pain since 29 February 2020.
I find it would be a remarkable coincidence for the underlying asymptomatic hip to become symptomatic as soon as the so-called irritability in the hip had resolved. The medical evidence, summarised above, shows that the continuation of symptoms from 29 February 2020, in my view, have not ceased or abated. I am satisfied that the weight of the medical evidence supports a finding that the injury has materially contributed to the need for surgery.
The respondent did refer to the recent report from Dr Punjabi and his history that the applicant has pain in both hips now. However, Dr Punjabi also has the history that the pain in the left hip is more than in the right hip. I find it is relevant that Dr Punjabi has not found that the applicant needs any treatment for his right hip. I find it is a fallacy to suggest that the situation in the left hip now must not be due to the injury because the right hip is symptomatic.

In terms of whether the proposed surgery is reasonably necessary the respondent noted that Dr Punjabi did refer to other forms of treatment but the respondent’s counsel, fairly, did not place reliance on this because Dr Gray opined that the surgery was reasonable. The test to be applied as to whether treatment is reasonably necessary is that discussed in Diab v NRMA Ltd[16] with Roche DP at [88] stating,
“In the context of s 60, the relevant matters, according to the criteria of reasonableness, include, but are not necessarily limited to, the matters noted by Burke CCJ at point (5) in Rose (see [76] above), namely:
(a)      the appropriateness of the particular treatment;
(b)      the availability of alternative treatment, and its potential effectiveness;
(c)      the cost of the treatment;
(d)      the actual or potential effectiveness of the treatment, and
(e)      the acceptance by medical experts of the treatment as being appropriate
and likely to be effective.”
[16] [2014] NSWWCCPD 72, Diab.
I am satisfied that the proposed total left hip replacement surgery and ancillary costs is reasonably necessary treatment. All doctors have advised it is the most effective and appropriate treatment for the applicant’s hip. The cost of the treatment is not excessive, particularly when one considers the benefits to the applicant should the surgery be successful. While there is alternate treatment such as using a walking stick, taking medication and putting up with the pain, I find they are not realistic options at this stage to ameliorate his pain. The applicant has not rushed into surgery, he has tried alternate treatment. I find that the evidence overwhelmingly satisfies the matters discussed in Diab. Accordingly, I find the proposed left hip surgery and ancillary treatment is reasonably necessary treatment as a result of the injury on 29 February 2020.
I order the respondent to pay the cost of the proposed surgery and ancillary expenses in accordance with the SIRA gazetted rates.

[2025] NSWPIC 444

28 August 2025