Marshall v Royal Freemasons' Benevolent Institution

CERTIFICATE OF DETERMINATION OF MEMBER
CITATION:	Marshall v Royal Freemasons' Benevolent Institution [2025] NSWPIC 493
APPLICANT:	Roma Marshall
RESPONDENT:	Royal Freemasons' Benevolent Institution
MEMBER:	Cameron Burge
DATE OF DECISION:	23 September 2025
CATCHWORDS:	WORKERS COMPENSATION - Workers Compensation Act 1987; claim for medical expenses; whether the applicant suffered injury to her hips in an accepted work-related fall; applicant suffered an accepted lumbar spine injury in a fall from a chair at work; there is no issue she suffered a lumbar spine injury in that fall; the applicant claims the costs of past and future treatment to not only the lumbar spine but also her bilateral hips, and for a right ankle/Achilles tendon strain (consequential); no issue was taken with any of the treatment modalities claimed; the dispute centred on the presence of any alleged injury and/or consequential condition; Held – having regard to the totality of the lay and medical evidence the applicant suffered bilateral hip injuries in the fall at issue; the applicant has not discharged her onus of proof in establishing her Achilles tendon/ankle strain occurred as a consequence of her injury; the respondent is ordered to pay the applicant’s reasonably necessary medical and treatment expenses in connection with her lumbar spine and hip injuries; award for the respondent on the claimed consequential condition to the right ankle/Achilles tendon.
DETERMINATIONS MADE:	The Personal Injury Commission (Commission) determines: 1. The applicant suffered injury to her lumbar spine and bilateral hips in the course of her employment with the respondent on 11 August 2020. 2. Award for the respondent on the claim for consequential condition to the right ankle/Achilles tendon. 3. The respondent is to pay the applicant’s reasonably necessary past and future medical and treatment expenses in relation to her lumbar spine and bilateral hips. A brief statement is attached setting out the Commission’s reasons for the determination.

STATEMENT OF REASONS

BACKGROUND

On 11 August 2020, the applicant, Roma Marshall, suffered injury when she slipped from a chair whilst in the course of her employment with Royal Freemasons Benevolent Institution (the respondent) and landed heavily on her buttocks.
There is no issue the applicant suffered an injury to her lumbar spine in the fall at issue. She brings a claim for the payment of reasonably necessary medical and treatment expenses in relation to both her lumbar spine and bilateral hips, which she also alleges were injured in the fall at issue. The respondent denies any hip injuries occurred in the relevant fall and also denies liability for an alleged consequential condition to the applicant’s right ankle/ Achilles tendon.

ISSUES FOR DETERMINATION

The parties agree that the following issues remain in dispute:
(a) whether the applicant suffered a bilateral hip injury in the fall at issue, and
(b) whether the applicant suffered a consequential condition to her right ankle/ Achilles tendon as a result of her work injury.

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.
The parties attended a hearing before me on 22 September 2025. Mr Hickey instructed by Ms Simmonds appeared for the applicant. Mr Gaitanis instructed by Mr Galea appeared for the respondent.

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 (the Application);
(b)    Reply, and
(c)    respondent’s Application to Lodge Additional Documents (ALAD) dated
19 September 2025, admitted without objection.

Oral evidence

There was no oral evidence called at the hearing.

FINDINGS AND REASONS

Whether the applicant suffered hip injuries in the fall at issue

The circumstances surrounding the applicant’s injury are not controversial. In her initial statement, the applicant set them out as follows:
“4.     On 11 August 2020 at 15:20 hours, after finishing some work on the computer, I turned the chair to stand when I noticed that my left shoelace was undone. I bent to tie the lace and the chair flew out from behind me and I fell onto the floor landing on my buttocks and jarring my lower back.
5.     I did not have pain initially, but it came on later that night. When the pain did not go away, I went to see Matt Hall (chiropractor) on 13 August 2020. I had been seeing a chiropractor consistently since my motor accident in 1987. I continued to see him on occasions until I claimed workers’ compensation. At this time, he told me that he was unable to continue treatment without a referral from my treating doctor. I was unable to obtain this due to GP refusal. I saw my chiropractor on the 13/8/20, 31/8/20, 7/9/20, 19/10/20, 17/12/20 and 4/4/21.
6.     The pain continued, so I went to see my general practitioner who asked that I have an MRI. I had an MRI of the lumbar spine on 25 October 2020.
7.     Within a couple of weeks of the fall, I started to feel pain in my groin and hips. I noticed this when I had trouble walking upstairs due to the pain. I reported this to my doctor who referred me for an x-ray of my pelvis and both hips. This was in mid-November.”
The respondent submits there are a number of inconsistencies and gaps in the applicant’s versions of events in relation to the alleged injury to her hips.
Mr Hickey took the Commission to the clinical records of the applicant’s chiropractor, Mr Hall.
Mr Gaitanis noted these records included some reference to prior groin and hip issues, as recently as 11 May 2020, only three months before the injury at issue.
Mr Hall’s clinical records are broadly consistent with the applicant’s statement. He recalled she attended two days after her fall, namely on 13 August 2020 at which time she complained of lumbar spine pain.
On 31 August 2020, the applicant again attended on Mr Hall and noted she had separately fallen onto her right knee. It is agreed this reference is to a separate incident to the injury at issue. There is no suggestion the applicant’s back or hip conditions arose from that fall, as the only body system referred to as being in pain after that incident was the right knee.
The applicant again attended on 7 September 2020, at which time there was a reference to her “still” having right hip and leg pain. That entry may either refer to the pre-existing pain suffered from May 2020, or to symptoms suffered in the incident at issue. As is often noted, care must be taken in relying on the clinical history obtained by busy treating practitioners to try to disavow the history provided by claimants: see Mason v Demasiand Anor [2009] NSWCA 227 (31 July 2009) per Basten JA. Regardless, what is apparent is the applicant was complaining of right hip problems only three weeks after the injurious event at issue.
The applicant continued to complain of right hip pain when she visited Mr Hall on
19 October 2020 and again on 4 January 2021, at which time she also complained of left hip pain and ongoing lumbar spine symptoms.
Notwithstanding the applicant having suffered from some prior hip issues, in my view the clinical records of Mr Hall are consistent with her account in her statement as to the onset of problems following the fall at issue. I have no difficulty accepting the applicant as a witness of truth, noting she has openly admitted in her evidence to prior lumbar spine issues and disclosed prior injuries to the relevant medical practitioners.
Although the respondent relied on a lack of complaint surrounding the hips in the incident/accident report form which was lodged on the date of injury, it should be noted there was no record of any lower back condition on that date, yet such an omission was not of itself relied on by the respondent to deny liability concerning the back injury. Moreover, the absence of any reference to injury in the incident report form is consistent with the applicant’s account that her pain came on later in the evening of the accident, and that it was only after it failed to resolve a couple of days that she attended on Mr Hall for treatment.
The applicant’s persistent symptoms ultimately led to a lumbar MRI being undertaken in October 2020, and also radiological investigation of her hips.
Her former treating surgeon, the late Dr Sharp noted in his report dated 28 October 2022 to the applicant’s general practitioner (GP) that cortisone injections for both of the applicant’s hips had taken away her pain. On that occasion, Dr Sharp arranged for a further cortisone injection into the left hip joint, which was of no benefit.
In his report dated 6 February 2023 to the applicant’s GP, Dr Sharp noted the applicant had undergone cortisone for both trochanteric bursae and her right hip joint, on three occasions which all worked. The fourth injection, into the applicant’s left hip did not. At this time, Dr Sharp offered to organise further injections for the applicant’s hips. However, she declined and asked for Panadeine Forte to help manage her pain.
On 20 July 2023, the applicant saw Dr Balendra, who was a colleague at the same practice as Dr Sharp. At that time, the applicant’s left hip was worse than the right, and Dr Balendra noted limited internal rotation together with an irritable hip joint and recommended re-imaging. After that imaging was undertaken, Dr Sharp again saw the applicant on
15 August 2023. Her scans had shown insertional enthesopathy of the gluteus minimus and medius affecting the applicant’s left hip, which would explain her gluteal pain.
At this point in time, the applicant’s treating surgeon recommended PRP injections. Approval for these injections was refused as the question of hip injury was, and remains, in issue. There is no medical evidence lodged by the respondent which disputes the medical necessity of any proposed treatment, rather the dispute is on the basis there is no injury to the applicant’s hips.
The applicant relies on the reports of Dr Hyde-Page, Independent Medical Examiner (IME) in support of her claim.
In describing the mechanism of injury, Dr Hyde-Page stated:
“I consider the nature of her heavy fall on her buttocks on 11 August 2020 caused the persistent or chronic mechanical lumbar back pain with which she now presents. It also caused excessive strain of the hip abductors and onset of chronic abductor or gluteus medius and gluteus minimus tendinosis and associated trochanteric bursitis of both hips.”
In relation to causation, Dr Hyde-Page opined the applicant’s hip injuries were caused in the frank incident on 11 August 2020. He stated:
“… she developed the lateral pain in both hips within a couple of days of her heavy fall to the extent that she could only sleep when she slightly turns to one side and could not sleep on either side due to the severity of the pain in the lateral side of her hips where she developed the abductor tendinosis and associated trochanteric bursitis. These acute injuries to her hips occurred at the same time she suffered her acute lower back injury on 11 August 2020.”
Dr Hyde-Page was specifically asked whether the applicant’s hip injuries were caused by altered biomechanics as a result of her back injury and stated:
“These ongoing complaints are not related to biomechanical problems. I would also add that her hip joints have remained relatively normal and not painful and she had normal examination of the hip joints today. All this significant pain is on the lateral side of her hips… For her lateral hip pain, she needs either cortisone or PRP injections and ongoing exercises. She needs pain and anti-inflammatory medication.”
Both Dr Hyde-Page and the respondents IME, Dr Machart have provided opinions in relation to the other’s reports. For his part, Dr Hyde-Page noted Dr Machart indicated there was no connection between the applicant’s heavy fall in August 2020 and associated lateral hip pain and trochanteric bursitis. Dr Hyde-Page stated Dr Machart:
“Fails to consider the fact that she developed bilateral hip pain when she fell due to the gluteus medius and gluteus minimus muscle strains causing tendinosis of the tendon attachments to the greater trochanters and associated onset of trochanteric bursitis as a consequence of this on both sides”.
According to Dr Hyde-Page:
“There is no doubt that the onset of left and right hip trochanteric bursitis would not have developed if she had not suffered the abductor muscle tendon strains to the attachment of the greater trochanters to then lead to her developing the bilateral trochanteric bursitis.”
For his part, Dr Machart indicated the applicant’s groin and hip pain was due to primary hip pathology. Dr Machart said:
“It is difficult to diagnose several pathological conditions, left hip arthritis, right hip arthritis, left hip bursitis, right hip bursitis, sacroiliitis and multilevel spondylosis as caused or aggravated by the single injury.”
In a supplementary report dated 11 November 2021, Dr Machart further examined the treating medical records and noted persistent hip pain. He described any aggravation to the applicant’s lumbar spine would have ceased by November 2021.
In a report dated 31 January 2022, Dr Machart maintain there was no hip injury suffered in the fall at issue.
In this initial report of 4 May 2021, Dr Machart had indicated the mechanism of the applicant’s fall was not in keeping with her sustaining any hip injury and Dr Machart did not diagnose any trochanteric bursitis. He answered if there was such a condition, it was not related to the injurious incident at issue.
Dr Machart did not indicate why it was the case that the presence of trochanteric bursitis would not be related to the injurious event at issue, nor did he provide an explanation as to why there was no link between the mechanism of injury and the applicant’s hip condition. Rather, he merely stated this was the case.
In a final report dated 19 September 2025, attached to the respondents ALAD, Dr Machart again stated he did not find evidence of injury to the trochanteric areas of the left hip or right hip which both were well away from the area injured, having fallen on her buttocks. The groin pain was due to primary hip pathology which was not caused by the injury:
“I assess several pathological conditions of self-reported, left arthritis, right hip arthritis, left hip bursitis, right hip bursitis, sacroiliitis and aggravation of multilevel spondylosis. I did not find connection between the injury and anything other than the aggravation of the pre-existing lumbar spondylosis. This was because of the high improbability of multiple pathologies caused by single fall. Specifically, when analysing the mechanisms of injury, she fell on her back and buttocks. The point of impact was buttocks. This is consistent with aggravation of lower back pain. It is not consistent with other claimed injuries such as left hip arthritis, right hip arthritis, left hip bursitis, right hip bursitis and sacroiliitis. There was no contact between the ground, the greater trochanters or hips. She fell on the buttocks, which is the pelvis and not the hips. This caused injury to the spine.”
Dr Machart attacked the findings of Dr Hyde-Page, noting it was not clear how the latter had diagnosed bilateral trochanteric bursitis, labral tear and also the claimed consequential condition of right Achilles tendinosis. Dr Machart stated:
“This pathology cannot be assessed as caused by the injury mechanism, by analysis of the mechanism of the fall, falling on the buttocks and not on the trochanters and by analysis of timelines, pain having developed a couple of weeks later. The labral tear in the hip was not caused by falling on her back. The mechanism of this injury was fall on the back and pelvis and not on the hip joints. A labral tear typically causes pinching type mechanical symptoms, and not the type of pain she is experiencing.”
Somewhat curiously, Dr Machart stated he believed it was an error to conduct an MRI investigation of the applicant’s hips, as such scans “commonly demonstrate pathology which is not related to the injury”. With respect to Dr Machart, it is somewhat unusual for a medical practitioner to call into question the utility of a radiological investigation as thorough as an MRI, noting it is the role of the practitioner who requests such an investigation to interpret the scans and decide what, if any, pathology might be present and, where applicable, to provide an opinion as to the pathology’s aetiology.
On balance, I am of the view the applicant did suffer an injury to her hips in the fall at issue. Such a finding is supported by not only IME Dr Hyde-Page, but also by the applicant’s treating surgeons Dr Sharp and Dr Balendra, the clinical records of her chiropractor Mr Hall and also her GP clinical records.
It is apparent Dr Sharp was of the view the hip complaint was linked to work, noting he requested approval on 15 August 2023 from the respondent’s insurer for PRP injections into the hips. It is axiomatic to say the doctor would not have done so if he was not of the view the hip conditions were caused by the fall at issue. Dr Sharp, as a treating practitioner, is entitled to be given considerable weight unless it can be shown the history provided to him was either materially deficient or inaccurate or that he has made a relevant error in his analysis of the pathology at issue. There is no suggestion this is the case.
In reporting to the applicant’s GP in August 2023, Dr Sharp noted clear bilateral hip pathology, which he attributed to the work injury.
On balance, I am persuaded of the presence of a hip injury caused by the fall at issue. The fact the applicant did not complain about such hip conditions for a matter of a few weeks after the injury is not, in my view, of great moment given her complaints since the fall have been consistent and in circumstances where she did not even attend for medical treatment for several days after the fall at issue, and at that time only on her back, because her symptoms did not manifest until the evening after the fall and she waited several days to see if they would persist. Such a course of action can hardly be said to be unreasonable or unusual.
Although Dr Machart does provide a view as to why he believes the mechanism of fall could not have caused injury to the hips, his opinion stands alone and in contrast to not only the applicant’s IME but also to her treating surgeon and her GP.
Mr Gaitanis noted the applicant’s former treating surgeon Dr Gooden indicated her hip issues were in fact an aggravation rather than caused by a frank injury on the date in question. He submitted, correctly in my view, that such a finding would be fatal to the applicant’s claim as she has sought to rely only on the frank injury at issue rather than any aggravation of an underlying condition.
However, Dr Gooden’s view also stands alone. The applicant’s later treating surgeons Dr Sharp, who examined her on many occasions and with the benefit of various radiological investigations over time and Dr Balendra who replaced Dr Sharp are also of the view the frank injury caused the hip conditions. This is consistent with the applicant’s IME and also the clinical records of her treating chiropractor.
In my view, the evidence satisfies me that the applicant suffered hip injury in the fall of issue on 11 August 2020.
Given there was no specific challenge to the treatment sought or that which has been undertaken, I will therefore make a general order that the respondent pay the applicant’s reasonably necessary medical and treatment expenses in relation to her bilateral hips, together with her lumbar spine.

Consequential condition to the right ankle/ Achilles tendon

The applicant does not need to demonstrate the presence of pathology sufficient to satisfy an injury as that term is described in s 4 of the Workers Compensation Act1987 (the 1987 Act) in order to establish a consequential condition. However, the applicant does need to satisfy the Commission of the presence of an unbroken chain of causation between the injuries as found and the onset of the right ankle condition, having undertaken a commonsense evaluation of the causal chain.
I do not have any difficulty accepting the applicant as a witness of truth in terms of extent of the condition which she suffers. However, in my view the evidence concerning causation in relation to the right ankle is, to put things generously, sparse.
There is no question the applicant did suffer issues with her right ankle in or about 2021. However, this condition has largely resolved. For his part, Dr Hyde-Page stated in his first report:
“She did suffer a right Achilles tendon strain when she went back to work in 2021 but this has now settled.”
Dr Hyde-Page was substantively silent as to causation in relation to the Achilles tendon. He stated the applicant’s employment was a substantial contributing factor to the subsequent right ankle and Achilles tendonitis strain; however, he does not give a reason as to why this is the case.
In his later report dated 9 October 2024, Dr Hyde-Page makes no mention of the applicant’s right ankle condition. As such, the only IME evidence which supports a right ankle/ Achilles consequential condition is the bare ipse dixit statement by Dr Hyde-Page in his first report that the applicants fall led to the right Achilles consequential condition. In my view, such evidence is insufficient to satisfy me of the presence of a consequential condition as a result of the injury.
On balance, I therefore find the applicant has not discharged the onus of proof in demonstrating a causal link between the hip and back injuries and her right Achilles strain/ ankle condition. In relation to this aspect of the claim, I prefer the view of Dr Machart, namely that the Achilles strain is not linked to the injurious event, and accordingly there will be an award for the respondent in relation to this aspect of the claim.

SUMMARY

As noted, there is no specific dispute with the nature of the treatment claimed by the applicant. It is therefore appropriate in the circumstances to make orders for the payment by the respondent of the applicant’s past and future medical and treatment expenses in accordance with the provisions of s 60 and s 59A of the 1987 Act.
Accordingly, the Commission will make their findings in order set out on Page 1 of the Certificate of Determination.

[2025] NSWPIC 493

23 September 2025