Lewis v Lewis - [2024] NSWPIC 590

CERTIFICATE OF DETERMINATION OF MEMBER
CITATION:	Lewis v Lewis & Anor [2024] NSWPIC 590
APPLICANT:	Daniel Lewis
RESPONDENT:	D.E LEWIS & M.A LEWIS
MEMBER:	Carolyn Rimmer
DATE OF DECISION:	21 October 2024
CATCHWORDS:	WORKERS COMPENSATION - Claim for proposed surgery to the lumbar spine namely an anterior cervical discectomy and fusion at C3-4 as a result of the injury on 1 February 2017; Held – the injury on 1 February 2017 made a material contribution to the need for cervical spine surgery proposed and that the medical treatment is reasonably necessary as a result of the injury.
DETERMINATIONS MADE:	The Commission determines: 1. Respondent to pay the applicant’s s 60 expenses in respect of the treatment proposed by Associate Professor Timothy Steel in his report of 20 October 2023, namely, an anterior cervical discectomy and fusion at C3-4 as a result of the injury on 1 February 2017. A brief statement is attached setting out the Commission’s reasons for the determination.

STATEMENT OF REASONS

BACKGROUND

The applicant, Daniel Lewis, (Mr Lewis) was employed by D.E Lewis & M.A Lewis (the respondent) as a scrap metal assistant. The respondent was insured by Employers Mutual (NSW) Limited (the insurer) at the relevant time.
In the course of his employment on 1 February 2017, Mr Lewis sustained an injury to his cervical spine, thoracic spine and both shoulders when he was operating ratchet straps on a truck.
Mr Lewis made a claim for medical treatment proposed by Associate Professor Timothy Steel in his report of 20 October 2023, namely, an anterior cervical discectomy and fusion at C3/4, as a result of the injury on 1 February 2017.
The respondent disputed liability for the claim for the proposed surgery to the cervical spine.

ISSUES FOR DETERMINATION

The parties agree that the following issue remains in dispute:
(a) whether Mr Lewis is entitled to the payment of medical expenses and, namely, the treatment proposed by Associate Professor Steel in his report of 20 October 2023 – s 60 of the Workers Compensation Act1987 (the 1987 Act).

PROCEDURE BEFORE THE PERSONAL INJURY COMMISSION

The parties attended a conciliation conference and arbitration via video link on 10 October 2024. Mr Lewis was represented by Mr Paul Stockley, who was instructed by Mr Dilan Kasturi of LHD Lawyers. The respondent was represented by Mr Paul Rickard, who was instructed by Ms Cherie Tippett of Moray and Agnew Lawyers. Ms Abi O from the insurer also attended the conciliation conference and arbitration.
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…

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 Lewis v Lewis

Details

AGLC: Lewis v Lewis [2024] NSWPIC 590
Case: [2024] NSWPIC 590
Decision Date: 21 October 2024

CaseChat Overview and Summary

The case of Lewis v Lewis was heard in the Workers Compensation Tribunal, where the claimant sought compensation for proposed cervical spine surgery arising from an injury sustained on 1 February 2017. The injury in question was an anterior cervical discectomy and fusion at C3-4, which the claimant argued was necessitated by the accident. The primary issue before the court was whether the injury materially contributed to the need for the proposed surgery, and if the medical treatment was reasonably necessary as a result of the injury.

The court meticulously examined the medical evidence presented by both parties to determine the causal relationship between the injury and the proposed surgery. It considered the medical records, expert opinions, and the overall context of the claimant's medical history. The tribunal found that the injury on 1 February 2017 did indeed make a material contribution to the need for the cervical spine surgery. The claimant's medical condition and the necessity for the proposed treatment were directly linked to the accident, satisfying the criteria for compensation under the Workers Compensation Act.

In light of the findings, the court ruled in favour of the claimant, affirming that the proposed surgery was reasonably necessary as a result of the injury. Consequently, the claimant was entitled to compensation for the proposed medical treatment. The tribunal issued an order that the respondent was to cover the costs associated with the surgery, reflecting the causal link established between the injury and the need for medical intervention.

Orders