Meyer v Gunnedah Shire Council

CERTIFICATE OF DETERMINATION OF MEMBER
CITATION:	Meyer v Gunnedah Shire Council [2024] NSWPIC 295
APPLICANT:	Jeanette Meyer
RESPONDENT:	Gunnedah Shire Council
MEMBER:	Sophie Jones
DATE OF DECISION:	3 June 2024
CATCHWORDS:	WORKERS COMPENSATION - Workers Compensation Act 1987; claim for compensation for medical treatment pursuant to section 60; whether the applicant sustained a consequential condition in her left shoulder as a result of the workplace injury to her right shoulder; whether the treatment expenses claimed for proposed left shoulder surgery are reasonably necessary; Held – the applicant sustained a consequential condition in her left shoulder; the left shoulder surgery proposed is reasonably necessary medical treatment pursuant to section 60; the respondent is to pay the applicant’s section 60 expenses in respect of the proposed left shoulder surgery and associated hospital fees, anaesthetist fees and rehabilitation costs.
DETERMINATIONS MADE:	The Commission determines: 1. The applicant sustained a consequential condition in her left shoulder as a result of the workplace injury to her right shoulder. 2. The surgery proposed by Dr Allan Young in his report dated 7 September 2023, specified as left shoulder arthroscopic release and manipulation + subacromial decompression + distal clavicle excision +/- rotator cuff repair, is reasonably necessary medical treatment, pursuant to s 60 of the 1987 Act. 3. The respondent is to pay the applicant’s s 60 expenses in respect of the left shoulder surgery proposed by Dr Young and associated hospital fees, anaesthetist fees and rehabilitation costs.

STATEMENT OF REASONS

BACKGROUND

On 15 August 2020, Ms Jeanette Meyer (the applicant) sustained an injury to her right shoulder while working as a lifeguard for Gunnedah Shire Council (the respondent). In February 2021, the applicant’s right shoulder injury was further aggravated in a subsequent incident that occurred at the same workplace.
Following physiotherapy and cortisone injections, the applicant underwent surgery to her right shoulder performed by Dr Allan Young on 23 March 2022, which was approved by StateCover Mutual Limited (the insurer).
The applicant made a claim on the insurer for a consequential condition in her left shoulder as a result of injury to her right shoulder and sought compensation for the cost of proposed left shoulder surgery.
The insurer issued notices pursuant to s 78 of the Workplace Injury Management and Workers Compensation Act 1998 (the 1998 Act) on 28 September 2023 and 4 December 2023, disputing liability for the left shoulder condition and the associated surgical procedure requested by Dr Young.
The present proceedings were commenced by lodgement of an Application to Resolve a Dispute (Application) in the Personal Injury Commission (Commission) on 25 March 2024.
The applicant seeks compensation pursuant to s 60 of the Workers Compensation Act 1987 (the 1987 Act) for the cost of left shoulder surgery proposed by Dr Young on 7 September 2023, specified as left shoulder arthroscopic release and manipulation + subacromial decompression + distal clavicle excision +/- rotator cuff repair, and associated hospital fees, anaesthetist fees and rehabilitation costs.

ISSUES FOR DETERMINATION

The parties agree that the following issues remain in dispute:
(a) whether the applicant sustained a consequential condition in her left shoulder as a result of the injury to her right shoulder, and
(b) whether the treatment expenses claimed are reasonably necessary as a result of an injury received by the applicant pursuant to s 60 of the 1987 Act.

PROCEDURE BEFORE THE COMMISSION

The parties appeared for conciliation conference and arbitration hearing on 17 May 2024, conducted by way of videoconference on the MS Teams platform. The applicant was represented by Mr Hickey of counsel, instructed by Ms Simmonds of RJ O’Halloran & Co. The respondent was represented by Mr Robison of counsel, instructed by Ms Amin of BBW Lawyers. The applicant attended the videoconference and representatives from the insurer and Gunnedah Shire Council were also in attendance.
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 before the Commission and considered in making this determination:
(a) Application and attached documents, and
(b) Reply and attached documents.
The applicant lodged an Application to Admit Late Documents on 14 May 2024 in respect of a supplementary medical report of Dr Alan Hopcroft dated 13 May 2024. The respondent did not consent to the inclusion of that document in the evidence. Following submissions from both parties, I determined pursuant to rule 67(4) of the Personal Injury Commission Rules 2021 that it was not necessary in the interests of justice to allow the applicant to introduce the additional evidence. The supplementary report of Dr Hopcroft dated 13 May 2024 therefore does not form part of the evidence considered.

Oral evidence

Neither party applied to adduce oral evidence or cross-examine any witness.

Applicant’s statement

The applicant’s evidence is set out in a signed statement dated 9 February 2024.[1]
[1] Application pages 1-4.
The applicant records that on 15 August 2020, she injured her right shoulder and neck while working in her capacity as a lifeguard. After a period of time off work, the applicant returned to work on restricted duties.
The applicant states that as a result of the pain and symptoms in her right shoulder, she placed more reliance on her left arm.
The applicant records that in February 2021, she experienced a further episode of pain to her right shoulder at work when endeavouring to pull down a heavy roller door. Following the incident in February 2021, the applicant was placed into an administrative role with the respondent.
The applicant states that as a result of the pain and symptoms in her right shoulder, she continued to place more reliance on her left arm and used her left arm for most activities at work. The applicant records that she was beginning to feel pain to her left shoulder.
The applicant underwent arthroscopic debridement and subacromial decompression surgery to her right shoulder in March 2022 which was performed by Dr Allan Young, orthopaedic surgeon. Her right arm was placed in a sling and she commenced physiotherapy.
The applicant notes that following her right shoulder surgery she was placed into a clerical position with the respondent, a role that included sorting paperwork and typing.
The applicant states that she needed to use her left arm to complete tasks as she continued to experience weakness in the right arm. She was guarded in her movements of her right shoulder and as a result placed greater reliance on her left arm. The applicant records that the pain in her left arm gradually increased and she complained to her general practitioner (GP) about her left shoulder.
Due to increasing pain in the left shoulder, the applicant’s GP referred her for ultrasound investigation and then to Dr Young.

Treating evidence

Treating medical reports were in evidence from shoulder, elbow and hand surgeon Dr Stephen Kemp,[2] physiotherapist Mr Matthew Rouse,[3] general practitioner Dr Mohammad Hassan[4] and orthopaedic surgeon Dr Allan Young.[5]
[2] Application pages 26-27.
[3] Application page 29.
[4] Application page 28.
[5] Application pages 19-25; Reply pages 29-34.
The applicant consulted Dr Kemp in relation to her right shoulder on 28 July 2021. Dr Kemp’s report[6] states that at that time, steroid injections to the right shoulder had given about three weeks’ relief but the applicant was experiencing loss of strength, limitation of movement and pain in the right shoulder. Dr Kemp states (in relation to the right shoulder):
“This is a very complex presentation. Whilst there may be elements of glenohumeral degenerative change, there is also what might be an impingement syndrome and even a frozen shoulder.”
[6] Application page 27.
The report of physiotherapist Mr Michael Rouse dated 25 May 2021,[7] recorded that progress of the applicant’s right shoulder had been slow despite good adherence to her exercise program.
[7] Application page 29.
On 1 November 2021, the applicant was referred by Dr Hassan to Dr Young for opinion and management of her right shoulder.[8]
[8] Application page 28.
The reports of Dr Young record the right shoulder surgery that was performed on 23 March 2022.[9]
[9] Application page 20.
Dr Young’s report dated 3 May 2022[10] records that six weeks following her right shoulder surgery, the applicant reported some ongoing pain in her shoulder “which is not unexpected at this stage”.
[10] Reply page 31.
It is noted that Dr Young’s report dated 28 July 2022[11] records that the applicant “still gets some discomfort with certain activities and reports some weakness with lateral movements of the arm”. Dr Young states that he is happy for the applicant “to use the shoulder for all of her desired activities as she feels comfortable and capable.”
[11] Application, page 22.
Dr Young’s report dated 17 November 2022[12] states,
“Jenny reports some ongoing stiffness about her right shoulder and intermittent discomfort, but is certainly much improved from prior to surgery.”
Dr Young then continues:
“Unfortunately Jenny has developed left shoulder pain during her recovery period. Jenny reports if anything that her pain symptoms have increased with time and attributes her symptoms to over use as she has been recovering from her right shoulder injury and required surgery. This would be a logical explanation.”
[12] Application, page 23.
Dr Young reports that he recommended an ultrasound guided cortisone injection, exercise physiology for both shoulders and an MRI scan.
Dr Young’s report dated 3 July 2023[13] states:
“Unfortunately Jeanette’s left shoulder has been come [sic] increasingly painful since I saw her last.
…
A repeat MRI scan has been performed and demonstrates persistent partial tearing within the supraspinatus tendon and associated bursitis. Shoulder joint is of normal appearance. There is AC joint arthritis. There is thickening and oedema of the capsule consistent with a capsulitis.
I expect that Jeanette’s left shoulder pain that was initially due to rotator cuff pathology is now deteriorated due to the development of a secondary capsulitis.”
[13] Application, page 24.
Dr Young recommended a guided cortisone injection, noting that a repeat injection may be needed.
Dr Young’s report dated 7 September 2023[14] states that the applicant continues to experience significant ongoing left shoulder pain and notes the cortisone injections only provided a fortnight of relief. Dr Young states that there is a good likelihood of alleviating the applicant’s symptoms with surgery in the form of “left shoulder arthroscopic release and manipulation + subacromial decompression + distal clavicle excision +/- rotator cuff repair”.
[14] Application page 25.
Clinical notes were in evidence from Mater Hospital,[15] where the applicant’s right shoulder surgery was performed, and Tamworth General Practice,[16] where the applicant consulted with Dr Hassan.
[15] Application pages 30-31.
[16] Application pages 32-50.
The Tamworth General Practice notes cover the period from 18 August 2020 to 14 May 2023.
The first note dated 18 August 2020[17] records the injury to the applicant’s right shoulder. The first reference in the GP notes to the left shoulder appears on 22 September 2022:[18]
“Lt [left] upper arm for 3 weeks.”
[17] Application page 32.
[18] Application page 45.
A subsequent consultation record dated 17 October 2022 states:[19]
“Rt [right] shoulder pain is improving. Still feels weak in the arm. Has got Lt shoulder / arm pain 4 months. Feels more pressure on Lt shoulder. Has been compensating for the Rt shoulder for over 2 years.”
[19] Application page 46.
That consultation record states the actions taken include an imaging request for an ultrasound scan:
“Ultrasound scan – Shoulder, Left (Lt shoulder pain 3-4 months pain worsening since last month. Bursitis / or over used to compensate. Left shoulder pain).”
The consultation record dated 14 November 2022 states:[20]
“Lt shoulder US [ultrasound] result. Worsening in Lt shoulder. Has been over using to compensate the Rt arm. Has not done much heavy just daily staff [sic]. Will be seeing the surgeon.”
[20] Application page 46.
The consultation record dated 23 January 2023 states:[21]
“Rt shoulder has been improving. Lt shoulder pain flared up. Was over doing on the Lt shoulder to compensate the Rt shoulder pain. Had steroid injection. Lt shoulder pain has not improved. The steroid injection did help temporarily for 10 days. Has been taking Voltaren. If not improves [sic] may have another steroid injection.”
[21] Application page 47.
A consultation record dated 20 February 2023[22] notes the left shoulder pain has been worsening, the last steroid injection helped for ten days but has worn off and the applicant was advised to take non-steroidal anti-inflammatory medication for four weeks.
[22] Application page 48.
Subsequent consultation records from March, April and May 2023 record worsening pain in the left shoulder and left arm.[23]
[23] Application pages 49-50.

Radiological investigation reports

An ultrasound report of the applicant’s left shoulder dated 10 November 2022[24] records the following clinical history:
“Clinical History: Left shoulder pain 3-4 months, pain worsening since last month. Bursitis / overuse to compensate right shoulder (right shoulder pain).”
[24] Application page 55.
The report’s conclusion was:
“Subscapularis and supraspinatus tendinopathy with partial thickness partial width tears as described. Subacromial / subdeltoid bursitis.”
An MRI report of the applicant’s left shoulder dated 20 December 2022[25] provides the following conclusion:
“Mild AC joint arthrosis. Mild subacromial/subdeltoid bursitis. Diffuse high-grade supraspinatus tendinosis most severe in its posterior third without discrete tear. Low-grade infraspinatus insertional tendinosis.”

Qualified evidence

[25] Application pages 56-57.

Dr Alan Hopcroft

The applicant relies on a report by Dr Alan Hopcroft, general surgeon orthopaedics, dated 8 December 2023.[26]
[26] Application pages 11-18.
Dr Hopcroft records the history of the injury to the applicant’s right shoulder on 15 August 2020 and notes that after that injury,
“She gradually also noticed, however, pain radiating to her left shoulder but she worked on being taken out of pool activities and placed in an administrative / clerical role only on a very restricted duties program and not undertaking any of her lifeguarding activities.
During the course of her recovery, she had suffered a second injury that occurred after she was in a restrictive duties role but still undertaking lifeguarding activities. She had been pulling down a roller door at the workplace and aggravated the pain in her right shoulder on or about February 2021 and following that aggravating problem, she was placed in the administrative role as detailed.
She then went back to see her general practitioner once more whom she had seen regularly to that time and was sent for an MRI scan of her cervical spine due to the paraesthesia and numbness that was occurring in her right arm particularly then”.
Dr Hopcroft records the results of an MRI of the applicant’s cervical spine which found:
“C5/6 disc protrusion but no impingement of the cord. No spondylotic myelopathy. Mild to moderate disc/osteophytic narrowing C6 neural foramina, especially on the left”.
Dr Hopcroft states:
“The patient went on to develop significant nerve root changes affecting her left arm and left hand.
However, in her continual use of her left arm to avoid aggravating her right shoulder problems, she developed quite marked pain around the left shoulder which increased significantly over throughout October 2022 and was sent by her general practitioner for an ultrasound of the left shoulder on 10 November 2022”.
Dr Hopcroft notes that following the right shoulder surgery on 23 March 2022, the applicant wore her right arm in a sling and attended physiotherapy and that after the MRI scan of her left shoulder, the applicant received a hydrocortisone and local anaesthetic injection into her left shoulder which provided some relief for two weeks. Dr Hopcroft records that the applicant had a second injection at a later time, again providing only a short period of improvement, and notes that on 7 September 2023, Dr Young recommended left shoulder surgery.
Under the heading “Current Status”, Dr Hopcroft records the applicant stopped work on 28 August 2023, continues to have ongoing and significant restriction of movement of the right shoulder but the pain has resolved to a significant degree. Dr Hopcroft records:
“She has ongoing and severe pain and restriction in movement of the left shoulder, worse than the right and that is what is causing her considerable distress currently disrupting her sleep pattern and compromising all activities where her left upper limb is involved”.
Dr Hopcroft notes that the applicant had no problems with the function of either shoulder prior to the work-related injury on 15 August 2020.
Under the heading “Diagnosis, Opinion and Prognosis”, Dr Hopcroft states:
“The diagnoses are:
Subacromial impingement with tendonitis of her right shoulder treated surgically and a significant frozen left shoulder with restricted movement, rotator cuff tear requiring the planned surgery that is being indicated by her treating orthopaedic specialist, Dr Allan Young.
…
In my opinion this patient, as a consequence of injuring her right shoulder at work on 15 August 2020 which ultimately came to surgery, developed consequential problems on the left shoulder by way of adhesive capsulitis (frozen shoulder) a problem which has certainly been aggravated by an unsuspected but significant cervical injury suffered at the same time on 15 August 2020.
There is therefore a causal connection between the injury to her right shoulder and the consequential injury to her left shoulder and cervical spine.
…
In my opinion, the patient requires the surgery articulated and requested by Dr Allan Young to her left shoulder if she is to make any significant advance towards rapid recovery of that pathology.
…
It is my opinion that this patient’s prognosis will be severely compromised if she does not progress to the surgery planned to her left shoulder and it is predictable that with that surgical intervention and a concerted treatment post-operatively to her left shoulder and to her cervical spine (as indicated) will see a radical improvement in this patient’s overall pain syndrome and upper limb compromised function.”

Associate Professor Paul Miniter

The respondent relies on the reports of A/Prof Miniter, orthopaedic surgeon, dated 20 November 2023[27] and 8 December 2023.[28]
[27] Reply pages 35-41.
[28] Reply pages 42-45.
In his report dated 20 November 2023, A/Prof Miniter records the history of injury as a “push/pull injury when she was moving some material at work” and states the injury occurred in 2018. In relation to the right shoulder surgery performed, A/Prof Miniter states:
“I am not certain of the indication of the surgery based on this scan as apart from some age-related tendinopathy of supraspinatus as she had an area of full-thickness cartilaginous loss (due to OA and not injury) over the glenoid. This is not an injury but rather longstanding pathology.”
In relation to the left shoulder, A/Prof Miniter states:
“The more recent development of this matter is that she has developed pain in her left shoulder without injury and with characteristics that are classically those of adhesive capsulitis. She has had two MRI scans, the more recent of which demonstrating classical features of adhesive capsulitis. In reality, the scans were not required as she developed severe pain, nocturnal exacerbation, restricted range of motion, and severe discomfort. The matter was exacerbated by attendance at a physiotherapist. All of these physical characteristics combined with the investigative findings and the history are simply consistent with frozen shoulder syndrome, which is the current presentation. There is a degree of tendinosis of supraspinatus which is identified on the MRI scan, but this is not the main clinical issue.”

A/Prof Miniter comments:
“I fail to understand the logic in suggesting surgical treatment in this case. This lady simply has frozen shoulder syndrome, and it is likely to settle either with a repeat intraarticular injection of corticosteroid, noting that she has already had one to my knowledge, and the passage of time. Her diabetic status needs to be checked.
The usual approach to matters such as this is to allow the pain to settle and then to allow physiotherapy to begin. It is most unusual to suggest that manipulation is necessary.”
The applicant’s daily activities are recorded as:
“assisting her husband in performing domestic duties”.
In relation to diagnosis and overuse, A/Prof Miniter states:
“The diagnosis is of adhesive capsulitis affecting the left shoulder. This is not caused by the workplace and is in no way related to her right shoulder. The commentary made by other observers that overuse of one shoulder has resulted as a consequence of surgical treatment to the right shoulder is not supported by the medical literature.
…
The left shoulder is not an aggravation of an underlying condition. She simply presents with capsulitis.
…
Her secondary employment is not consistent with overuse. This matter is one of disease. It is not caused by the workplace.
…
In my opinion, the matter itself presents without injury and is very clearly that of a frozen shoulder. You will note that this is mentioned in Dr Young’s report.”
In his supplementary report dated 8 December 2023, A/Prof Miniter states that the applicant is capable of working in an administrative role, 20 hours a week, with no involvement of her shoulders.

Surveillance report

A surveillance report from Procare, dated 21 November 2023, was included in the Reply.[29] The report details surveillance of the applicant that was carried out from 8 November 2023 to 10 November 2023.
[29] Reply pages 17-28.
During this period, the applicant was observed undertaking activities including parking her car, carrying her handbag over her right shoulder, retrieving items from her bag with her right hand, opening a car door with her left hand, closing the boot door of a car with her right hand, pushing a shopping trolley with both hands, loading groceries into the boot of a car predominantly with her right hand and arm with the support of her left hand, carrying a small bag in her left hand, carrying a shopping bag in her right hand and transferring it to her left while she opened the car door and then lifting the bag into the car with her right hand.

SUBMISSIONS

The parties made oral submissions at the arbitration hearing.

Applicant’s submissions

In summary, the applicant’s submissions were that:
(a)    Roche DP set out the relevant test in Murphy v Allity Management Services [2015] NSWWCCPD 49 at [58]: the worker only has to establish, applying the commonsense test of causation in Kooragang Cement Pty Ltd v Bates (1994) 35 NSWLR 452; 10 NSWCCR 796, that the treatment is reasonably necessary as a result of injury. That is, the worker has to establish that the injury materially contributed to the need for the surgery.
(b)    Following the applicant’s right shoulder surgery, she had restriction in that shoulder. Physiotherapy caused her pain, so she was put into an administrative role at work and her pain was managed with anti-inflammatory medication. At this point, the applicant still had capacity to work eight hours a day, five days a week.
(c)    The first indicator of left arm symptoms is in the GP clinical notes of 22 September 2022 and following entries record the left shoulder worsening while there was improvement in the right shoulder.
(d)    Dr Young’s reports record the improvement of the right shoulder after surgery and deterioration of the left shoulder. Dr Young recommends the surgery for the left.
(e)    Dr Hopcroft examined the history of the injury to the right shoulder on 15 August 2020 and the further aggravation in February 2021. He recorded the surgery on the right shoulder and subsequent wearing of a sling, physiotherapy and light duties. He examined the history of the left shoulder becoming restricted, more painful and considerably compromised in function. Dr Hopcroft examined the development of the increasing symptoms in the left shoulder and noted the recommendation for surgery.
(f)    Dr Hopcroft examined the surgery not just to relieve the frozen shoulder but also for the additional pathology that was identified in the MRI scan.
(g)    Dr Hopcroft set out the diagnosis in relation to the right shoulder and left shoulder, being a significant frozen left shoulder with restricted movement and rotator cuff tear requiring surgery.
(h)    Dr Hopcroft found a causal connection between the injury to the right shoulder and the consequential condition in the left shoulder and cervical spine and stated that the applicant requires surgery if she is no make any significant advance towards recovery and her prognosis will be severely compromised if she does not progress to the left shoulder surgery.
(i)    Applying Diab v NRMA Ltd [2014] NSWWCCPD 72, Rose v Health Commission (NSW) [1986] NSWCC 2; (1986) 2 NSWCCR 32 and Bartolo v Western Sydney Area Health Service [1997] NSWCC 1, the applicant has suffered a consequential condition to the left shoulder as a result of injury on 15 August 2020. There is sufficient evidence in the GP’s clinical notes and the reports of Dr Young as considered by Dr Hopcroft.
(j)    The history is of progression of left shoulder pain due to overuse, significantly developing after the right shoulder surgery while wearing the sling.

Respondent’s submissions

In summary, the respondent’s submissions were that:
(a)    in most cases, adhesive capsulitis is a constitutional condition, not the result of overuse.
(b)    The applicant’s statement is that after the right shoulder surgery, she returned to work and was placed in a clerical position, sorting paperwork and cards, on a reduced number of work hours. This is contrasted with her previous role which involved a degree of heavy work. Both the applicant’s work hours and the heaviness of the work were reduced following right shoulder surgery.
(c)    It appears Dr Hopcroft was not provided with the report of A/Prof Miniter and he did not engage with it.
(d)    Dr Hopcroft has also not engaged with the underlying facts of the matter and the reality of the case and therefore his report should be given low weight, following Paric v John Holland Constructions Pty Ltd [1985] HCA 58.
(e)    Dr Hopcroft’s opinion is based on generalities and not on the specifics of the case which are revealed by the surveillance evidence. In reality, there has not been an overuse of the left shoulder.
(f)    The expectation of Dr Young was that the applicant would wear a sling for 10 days and start a strengthening program within six weeks. This would suggest that it was unlikely that the right shoulder symptoms would continue to a significant degree for a significant period.
(g)    In Dr Young’s report of 28 July 2022, he says he is happy for the applicant to use the shoulder for all of her desired activities as she feels comfortable and capable.
(h)    Dr Young’s reference on 17 November 2022 to the left shoulder is merely an acceptance by the doctor of the patient’s hypothesis, it is not a medical opinion about causation. Dr Young simply says this would be a logical explanation after he recorded what the patient believes.
(i)    On 3 July 2023, Dr Young expressed a view of secondary capsulitis which is his analysis.
(j)    Dr Kemp refers to degenerative change as a possibility and also to frozen shoulder, both of which would not be regarded as injuries.
(k)    The reference in the ultrasound report dated 10 November 2022 to a clinical history of overuse is the history as provided and not an opinion by the radiologist.
(l)    The applicant has not joined issue with the content of the Procare investigation report. Accordingly, the Commission is invited to draw an inference following the rule in Jones v Dunkel (1959) 101 CLR 298 that the worker was not capable of giving any favourable evidence in respect of this material.
(m)     The surveillance evidence is evidence of the worker apparently having no difficulty with her ordinary activities of life including the use of both shoulders. If it was an overuse condition, you would expect it to be the left hand being favoured to undertake the activities rather than the right.
(n)    The factual evidence is not addressed by either the applicant or Dr Hopcroft and Dr Hopcroft’s opinion should be given a very low weight.
(o)    A/Prof Miniter’s opinion is that both the right and left shoulder are underlying constitutional conditions which have taken their course. One has taken a natural course and manifested later (the left) and one has taken an unnatural course, being the two incidents at work that rendered the right shoulder symptomatic.
(p)    A/Prof Miniter expresses concern about the logic of the suggested treatment commenting that the applicant simply has frozen shoulder which is likely to settle. The suggested treatment is not reasonable as the condition will likely go away by itself or with the aid of further injections.
(q)    A/Prof Miniter does not suggest that the applicant needs to favour one shoulder over the other to undertake domestic duties. He gives the diagnosis of adhesive capsulitis and states that it is in no way related to the right shoulder. A/Prof Miniter also says the consequential condition is not supported by medical literature.
(r)    There are multiple references in the evidence to frozen shoulder including by Dr Young.
(s)    The applicant’s onus requires her to demonstrate medical causation and the only way of demonstrating causation of that nature is with expert evidence. Dr Hopcroft’s report does not reflect the reality of the matter, that is, the activities which the surveillance report shows the worker has been doing, noting that the applicant does not join issue with that report.
(t)    In the alternative, the surgery to the left shoulder is not necessary in any event.

Applicant’s submissions in reply

In summary, the applicant’s submissions in reply were that:
(a) the surveillance material does not disclose anything of alarm. It shows the applicant undertaking some fairly light daily life activities which are not denied, including carrying a bag over her right shoulder and minimal use of the left arm.
(b) At the time of the surveillance footage, the applicant’s right arm had improved.

FINDINGS AND REASONS

Consequential condition

The applicant’s case is that her left shoulder condition is a consequence of the work injury she sustained to her right shoulder on 15 August 2020 and aggravated at work in February 2021.
It is not necessary for the applicant to establish that a consequential condition is itself an “injury” as defined in s 4 of the 1987 Act. In Moon v Conmah Pty Ltd [2009] NSWWCCPD 134, Roche DP stated at [45]:
“It is therefore not necessary for Mr Moon to establish that he suffered an ‘injury’ to his left shoulder within the meaning of that term in section 4 of the 1987 Act. All he has to establish is that the symptoms and restrictions in his left shoulder have resulted from his right shoulder injury. Therefore, to the extent that the Arbitrator and Dr Huntsdale approached the matter on the basis that Mr Moon had to establish that he sustained an ‘injury’ to his left shoulder in the course of his employment with Conmah they asked the wrong question.”
Roche DP continued at [46]-[47]:
“The test of causation in a claim for lump sum compensation is the same as it is in a claim for weekly compensation, namely, has the loss ‘resulted from’ the relevant work injury (see Sidiropoulos v Able Placements Pty Limited [1998] NSWCC 7; (1998) 16 NSWCCR 123; Rail Services Australia v Dimovski & Anor [2004] NSWCA 267; (2004) 1 DDCR 648).
The Court of Appeal considered the meaning of the expression ‘results from’ in Kooragang Cement Pty Limited v Bates (1994) 35 NSWLR 452 (‘Kooragang’) where Kirby P (as his Honour then was) said at 463-4;
‘The result of the cases is that each case where causation is in issue in a workers compensation claim, must be determined on its own facts. Whether death or incapacity results from a relevant work injury is a question of fact. The importation of notions of proximate cause by the use of the phrase “results from”, is not now accepted. By the same token, the mere proof that certain events occurred which predisposed a worker to subsequent injury or death, will not, of itself, be sufficient to establish that such incapacity or death “results from” a work injury. What is required is a common sense evaluation of the causal chain. As the early cases demonstrate, the mere passage of time between a work incident and subsequent incapacity or death, is not determinative of the entitlement to compensation. In each case, the question whether the incapacity or death “results from” the impugned work injury...is a question of fact to be determined on the basis of the evidence, including, where applicable, expert opinions’.”
Therefore, based on the evidence, I must be satisfied that the applicant’s left shoulder condition has resulted from her right shoulder injury, using a commonsense evaluation of the causal chain.
The applicant bears the onus of proof.
I observe that a finding of a consequential condition is not necessarily dependent on diagnosis: Arquero v Shannons Anti Corrosion Engineers [2019] NSWWCCPD 3. However, in this case I am of the view, given the competing medical evidence, that it is necessary to identify the pathology causing the applicant’s symptoms.
The applicant’s case is that the left shoulder condition was diagnosed by Dr Hopcroft as “significant frozen left shoulder with restricted movement, rotator cuff tear”[30] and described by Dr Young on 3 July 2023, with reference to the MRI scan results, as “persistent partial tearing within the supraspinatus tendon and associated bursitis. … There is AC joint arthritis. There is thickening and oedema of the capsule consistent with a capsulitis.”[31]
[30] Application page 17.
[31] Application page 24.
Dr Young considered the applicant’s left shoulder pain “that was initially due to rotator cuff pathology is now deteriorated due to the development of a secondary capsulitis.”
The respondent’s case, relying on the report of A/Prof Miniter, is that the symptoms in the applicant’s left shoulder are adhesive capsulitis / frozen shoulder, which is a constitutional condition.
The respondent has also referred to Dr Kemp’s report and Dr Young’s comments regarding frozen shoulder. I observe that Dr Kemp’s comments in his report dated 28 July 2021 are only concerned with the applicant’s right shoulder and Dr Young has referred to the MRI findings as well as the development of a secondary capsulitis.
I note the ultrasound of the left shoulder dated 10 November 2022[32] reported:
“Subscapularis and supraspinatus tendinopathy with partial thickness partial width tears as described. Subacromial / subdeltoid bursitis.”
[32] Application page 55.
The MRI report of the applicant’s left shoulder dated 20 December 2022[33] reported,
“Mild AC joint arthrosis. Mild subacromial/subdeltoid bursitis. Diffuse high-grade supraspinatus tendinosis most severe in its posterior third without discrete tear. Low-grade infraspinatus insertional tendinosis.”
[33] Application pages 56-57.
I consider that Dr Young and Dr Hopcroft provide a more detailed diagnosis of the applicant’s left shoulder condition than A/Prof Miniter, who considered that although, “there is a degree of tendinosis of supraspinatus which is identified on the MRI scan ... this is not the main clinical issue” and the applicant presented with “classical features of frozen shoulder syndrome on the left”.[34]
[34] Reply pages 36-37.
In contrast, both Dr Young and Dr Hopcroft refer to the radiological findings and found there was both frozen shoulder and additional pathology present in the left shoulder. I therefore find their opinions more persuasive.
It is necessary to consider the cause of the left shoulder condition, using a commonsense evaluation of the causal chain.
The applicant’s case is that the cause of her left shoulder condition is overuse of her left arm and left shoulder following the injury to her right shoulder and subsequent right shoulder surgery.
The respondent’s case is that firstly, there was no overuse of the left shoulder, relying on the fact that the applicant was moved to a clerical role at work on reduced hours and the surveillance evidence, and secondly, that overuse does not cause frozen shoulder.
The applicant’s evidence in her statement is that following the initial injury to her right shoulder on 15 August 2020, she returned to work on restricted duties and placed more reliance on her left arm due to the pain and symptoms in her right shoulder. After the aggravating incident in February 2021, she was placed in an administrative role. The applicant’s evidence is that she continued to use and place reliance on her left arm for most work activities and began to have pain in her left shoulder. The applicant records that following the surgery to her right shoulder, her right arm was in a sling. She was placed into a different clerical role involving sorting paperwork and typing. She used her left arm to complete tasks due to continuing weakness in her right arm and she was guarded in her movements of her right shoulder.
The right shoulder surgery was performed on 23 March 2022. Dr Young’s report dated 3 May 2022 (six weeks post-surgery) recorded the applicant had some ongoing pain in her right shoulder and his report dated 28 July 2022 (four months post-surgery) recorded that the applicant “still gets some discomfort with certain activities and reports some weakness with lateral movements of the arm” although he was happy for the applicant to use her shoulder “for all of her desired activities as she feels comfortable and capable”.[35]
[35] Application, page 22.
Despite Dr Young stating that he was happy for the applicant to use her right shoulder if she felt capable, I do not consider this negates the applicant’s evidence that she had weakness in her right arm following surgery, as Dr Young also recorded that the applicant was still getting some discomfort and reported some weakness.
The applicant reported pain in her left shoulder to her GP on 22 September 2022. On 17 October 2022, the GP notes record that:[36]
“Rt [right] shoulder pain is improving. Still feels weak in the arm. Has got Lt [left] shoulder / arm pain 4 months. Feels more pressure on Lt shoulder. Has been compensating for the Rt shoulder for over 2 years.”
[36] Application page 46.
This is the first reference in the medical evidence that the applicant had been compensating for the injured right shoulder by using her left. The GP referral of the applicant for an ultrasound scan refers to “Bursitis / or over used to compensate”.[37]
[37] Application page 46.
The GP consultation records from 14 November 2022 and 23 January 2023 both refer to the applicant overusing the left shoulder to compensate the right arm / shoulder, with the record from the 23 January 2023 noting the right shoulder had been improving although there was restriction of range of motion but the left shoulder pain had flared up as the applicant was “over doing” it with the left shoulder to compensate the right.[38]
[38] Application pages 46-47.
Whilst the respondent has submitted that simply recording the applicant’s hypothesis about the cause of her left shoulder symptoms does not amount to a medical finding of causation, there is nothing in the GP notes to suggest that the GP did not accept overuse or compensation as a plausible explanation. The referral for an ultrasound scan of the left shoulder refers to “bursitis / or over used to compensate” and this is repeated in the clinical history in the ultrasound report, 10 November 2022:[39]
“Clinical History: Left shoulder pain 3-4 months, pain worsening since last month. Bursitis / overuse to compensate right shoulder (right shoulder pain).”
[39] Application page 55.

The fact that the referring doctor included this in the clinical history infers that he did not reject it as a cause.
Similarly, the applicant reported to Dr Young on 17 November 2022 that she had developed left shoulder pain during her recovery period following right shoulder surgery. Dr Young states:[40]
“Jenny reports if anything that her pain symptoms have increased with time and attributes her symptoms to over use as she has been recovering from her right shoulder injury and required surgery. This would be a logical explanation.”
[40] Application page 23.
Whilst Dr Young’s statement, “This would be a logical explanation”, is not an independent medical opinion of causation, it is more than a mere recording of the applicant’s hypothesis: it is an acceptance of the applicant’s explanation that it is logical that the applicant’s symptoms have arisen through overuse. Dr Young does not express doubt or disagreement with this explanation and his comment is his own opinion as to whether it is a plausible explanation for the development of the applicant’s left shoulder symptoms.
In relation to the applicant’s argument regarding overuse, the respondent submits that following surgery the applicant was working a reduced number of hours in a clerical role.
The applicant’s evidence is that even before the second incident in February 2021,
“As a result of the pain and symptoms in my right shoulder, I felt as though I was placing more reliance on my left arm.”[41]
[41] Application page 2.
Following the incident in February 2021, the applicant was placed in an administrative role and states:[42]
“…as a result of the pain and symptoms I was experiencing in my right shoulder, I was placing a greater reliance on my left shoulder. I was using my left arm for most activities at work. I was beginning to feel pain to my left shoulder. My pain continued to worsen. However, my right shoulder complaints remained worse.”
[42] Application page 2.
The applicant’s evidence is that after her surgery she was placed in a different role which was a clerical position involving sorting paperwork and typing.
As noted above, the applicant first reported pain in her left shoulder to her GP on 22 September 2022. The GP clinical notes dated 14 November 2022 state:[43]
“Lt shoulder US result. Worsening in Lt shoulder. Has been overusing to compensate the Rt arm. Has not done much heavy just daily staff [sic]”
[43] Application page 46.
It is the applicant’s evidence that she was overcompensating for her right shoulder for two years before she reported pain to her GP. I do not consider that the fact the applicant was placed in a clerical role after March 2022 negates her evidence of overuse of the left arm since August 2020.
In relation to the qualified evidence, I consider that Dr Hopcroft took a far more detailed history of the applicant’s right shoulder injury than A/Prof Miniter, who recorded:[44]
“…she had what she regards as a push/pull injury when she was moving some material at work. This occurred back in 2018. It was followed by an MRI scan, which I have seen. The scan was dated 24/01/2022.”
[44] Reply page 36.
It is noteworthy that not only did A/Prof Miniter record an incorrect date for the original right shoulder injury (which occurred on 15 August 2020, not in 2018), but he also did not record any mention of the second aggravating incident that occurred in February 2021.
In relation to the development of the applicant’s left shoulder symptoms, Dr Hopcroft recorded that following right shoulder surgery:[45]
“…in her continual use of her left arm to avoid aggravating her right shoulder problems, she developed quite marked pain around the left shoulder which increased significantly over throughout October 2022”.
[45] Application page 13.
In relation to the development of the applicant’s left shoulder symptoms, A/Prof Miniter recorded:[46]
“…she has developed pain in her left shoulder without injury and with characteristics that are classically those of adhesive capsulitis. …The matter was exacerbated by attendance at a physiotherapist.
…
There is no history of injury in relation to the left shoulder.”
[46] Reply pages 36-37.
In relation to the surveillance evidence, the evidence covers a three day period from 8 November 2023 to 10 November 2023 and as described above, shows the applicant undertaking a range of daily activities including driving and parking, opening and closing car doors, carrying a handbag, pushing a shopping trolley and putting groceries into the boot of a car. The majority of these activities are undertaken with the applicant’s right hand and arm. The respondent submits that if the applicant were overusing her left arm, she would not be using her right arm for these activities.
I prefer the applicant’s submissions on this issue. The surveillance was undertaken in November 2023, whereas the applicant reported her left shoulder had become painful in September 2022 due to overuse and compensating for her right shoulder over the previous two years. By the time the surveillance was undertaken in late 2023, it is the applicant’s case that her right shoulder had improved and her left shoulder was worse.
Dr Hopcroft’s examination of the applicant in December 2023 recorded the applicant continued to have significant restriction in movement of the right shoulder but pain had resolved to a significant degree, while she had ongoing and severe pain and restriction in the left shoulder “worse than the right and that is what is causing her considerable distress currently disrupting her sleep pattern and compromising all activities where her left upper limb is involved”.[47]
[47] Application page 15.
A/Prof Miniter’s physical examination of the applicant in November 2023 also showed:[48]
“She presents with classical features of frozen shoulder syndrome on the left. She has an acceptable range of motion of the right shoulder at 130° of forward elevation and 100° of abduction. External rotation ranges to 40°. On the left, she has a markedly positive jerk sign and could not abduct more than 60°. There are no features of impingement, which is simply unable to be tested in a situation such as this with such an irritable shoulder.”
[48] Reply page 37.
I find that the surveillance evidence is therefore in keeping with the medical evidence that by November 2023, the applicant’s left shoulder was more restricted and significantly more painful than her right shoulder. It therefore stands to reason that the applicant was observed using her right arm and shoulder more than her left in November 2023. I do not draw any inference from the surveillance material that is detrimental to the applicant’s case.
In relation to causation, Dr Hopcroft referred to applicant’s consultations with her GP and Dr Young, recorded the radiology findings in detail and then provided his opinion that:[49]
“In my opinion this patient, as a consequence of injuring her right shoulder at work on 15 August 2020 which ultimately came to surgery, developed consequential problems on the left shoulder by way of adhesive capsulitis (frozen shoulder) a problem which has certainly been aggravated by an unsuspected but significant cervical injury suffered at the same time on 15 August 2020.
There is therefore a causal connection between the injury to her right shoulder and the consequential injury to her left shoulder and cervical spine.”
[49] Application page 17.
A/Prof Miniter’s opinion was:[50]
“The more recent development of this matter is that she has developed pain in her left shoulder without injury and with characteristics that are classically those of adhesive capsulitis. She has had two MRI scans, the more recent of which demonstrating classical features of adhesive capsulitis. In reality, the scans were not required as she developed severe pain, nocturnal exacerbation, restricted range of motion, and severe discomfort. The matter was exacerbated by attendance at a physiotherapist. All of these physical characteristics combined with the investigative findings and the history are simply consistent with frozen shoulder syndrome, which is the current presentation. There is a degree of tendinosis of supraspinatus which is identified on the MRI scan, but this is not the main clinical issue.”
[50] Reply page 36.
The respondent submits that I should place little weight on the report of Dr Hopcroft as it is expressed in generalities and does not deal with the reality of the facts of the case. The respondent submits I should prefer A/Prof Miniter’s opinion that the applicant “simply has frozen shoulder syndrome” which is not caused by the workplace and is in no way related to her right shoulder.
I do not agree with this submission. Dr Hopcroft’s report sets out a detailed history of the right shoulder injury and left shoulder symptoms, the radiological findings and the treating doctors’ records. In addition, Dr Hopcroft’s diagnosis is more detailed than that of A/Prof Miniter. I have already described Dr Hopcroft’s opinion as persuasive and I give considerable weight to his report.
Having regard to all the evidence, I am satisfied on the balance of probabilities that the applicant’s left shoulder condition is a consequence of the injury she sustained to her right shoulder.
By the time the applicant reported left shoulder pain to her GP in September 2022, the applicant reported that she had been compensating for her right arm for the past two years: since the original injury in August 2020, the aggravation in February 2021 and the surgery in March 2022. Whilst it is true that the applicant was placed first on restricted duties at work and then in a clerical position, this does not negate the applicant’s evidence that she was overusing her left arm and compensating for her right throughout this time.
The applicant’s explanation for the cause of her left shoulder symptoms was not rejected by her GP and Dr Young considered it “a logical explanation”. Dr Hopcroft’s opinion was also that the applicant’s left shoulder conditions were a consequence of her right shoulder injury.
A/Prof Miniter’s opinion is that frozen shoulder is a disease and is in no way related to the right shoulder and that “overuse of [the left] shoulder has resulted as a consequence of surgical treatment to the right shoulder is not supported by the medical literature”.[51]
[51] Reply page 38.
Dr Hopcroft, however, gives a more detailed diagnosis of the left shoulder condition and this is supported by Dr Young and the radiology, noting Dr Young’s opinion that he expects the applicant’s pain was initially due to rotator cuff pathology and is now deteriorated due to the development of a secondary capsulitis.
Having regard to the evidence and a commonsense evaluation of the causal chain, I am satisfied on the balance of probabilities that the applicant’s condition to her left shoulder arose due to overuse and is a consequence of the accepted work injury she sustained to her right shoulder.

Reasonably necessary medical treatment

Section 60 of the 1987 Act relevantly provides:
“(1) If, as a result of an injury received by a worker, it is reasonably necessary that-
(a)any medical or related treatment (other than domestic assistance) be given, or
(b)any hospital treatment be given, or
(c)any ambulance service be provided, or
(d)any workplace rehabilitation service be provided,
the worker’s employer is liable to pay, in addition to any other compensation under this Act, the cost of that treatment or service and the related travel expenses specified in subsection (2).”
The medical treatment claimed by the applicant is surgery in the form of “left shoulder arthroscopic release and manipulation + subacromial decompression + distal clavicle excision +/- rotator cuff repair”, recommended by Dr Young in his report dated 7 September 2023.[52]
[52] Application page 25.
Section 60(1) of the 1987 Act requires that the treatment is given as a result of an injury received by a worker and that it is reasonably necessary that it be given. Therefore, there is both a causation test and a reasonably necessary test to be satisfied.
In relation to causation, Roche DP held in Murphy v Allity Management Services Pty Ltd [2015] NSWWCCPD 49 at [58] that the applicant:
“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).”
The “injury” in the present case is the injury to the applicant’s right shoulder. I have already found that there is a causal link between the right shoulder injury and the left shoulder condition.
What constitutes reasonably necessary treatment was considered by Burke CCJ in Rose v Health Commission (NSW) [1986] NSWCC 2; (1986) 2 NSWCCR 32. His Honour stated:
“In determining whether a particular regimen is medical treatment and whether it is reasonably necessary that such be afforded to a worker and that such necessity results from injury, it appears to me some general principles can be stated:
1. Prima facie, if the treatment falls within the definition of medical treatment in section 10(2), it is relevant medical treatment for the purposes of this Act. Broadly then, treatment that is given by, or at the direction of, a medical practitioner or consists of the supply of medicines or medical supplies is such treatment.
2. However, though falling within that ambit and thereby presumed reasonable, that presumption is rebuttable (and there would be an evidentiary onus on the party seeking to do so). If it be shown that the particular treatment afforded is not appropriate, is not competent to alleviate the effects of injury, then it is not relevant treatment for the purposes of the Act.
3. Any necessity for relevant treatment results from the injury where its purpose and potential effect is to alleviate the consequences of injury.
4. It is reasonably necessary that such treatment be afforded a worker if this Court concludes, exercising prudence, sound judgment and good sense, that it is so. That involves the Court in deciding, on the facts as it finds them, that the particular treatment is essential to, should be afforded to, and should not be forborne by, the worker.
5. In so deciding, the Court will have regard to medical opinion as to the relevance and appropriateness of the particular treatment, any available alternative treatment, the cost factor, the actual or potential effectiveness of the treatment and its place in the usual medical armoury of treatments for the particular condition.”
In Bartolo v Western Sydney Area Health Service [1997] NSWCC 1, Burke CCJ further stated:
“The question is should the patient have this treatment or not. If it is better that he have it, then it is necessary and should not be forborne. If in reason it should be said that the patient should not do without this treatment, then it satisfies the test of being reasonably necessary.”
Dr Young’s report of 7 September 2023[53] states that the applicant “continues to experience significant ongoing left shoulder pain”, noting the cortisone injections only provided a fortnight of relief. Dr Young states:
“We discussed further treatment options and Jenny has reached a stage now where she is frustrated by the duration of her ongoing pain symptoms and the impact this has on her life. I believe there is a good likelihood of alleviating her symptoms with surgery in the form of a left shoulder arthroscopic release and manipulation + subacromial decompression + distal clavicle excision +/- rotator cuff repair. An MRI scan from June demonstrated a partial and mostly intrasubstance tear of the supraspinatus that will be assessed at the time of surgery to see whether repair is warranted or not.”
[53] Application page 25.
The surgery proposed by Dr Young is supported by Dr Hopcroft who states:[54]
“In my opinion, the patient requires the surgery articulated and requested by Dr Allan Young to her left shoulder if she is to make any significant advance towards rapid recovery of that pathology.
…
It is my opinion that this patient’s prognosis will be severely compromised if she does not progress to the surgery planned to her left shoulder and it is predictable that with that surgical intervention and a concerted treatment post-operatively to her left shoulder and to her cervical spine (as indicated) will see a radical improvement in this patient’s overall pain syndrome and upper limb compromised function.”
[54] Application page 17.
A/Prof Miniter states in his report that, in his opinion, there was no clear indication for surgery to the right shoulder and she does not require surgical treatment for her left shoulder. A/Prof Miniter states:[55]
“I fail to understand the logic in suggesting surgical treatment in this case. This lady simply has frozen shoulder syndrome, and it is likely to settle either with a repeat intaarticular injection of corticosteroid, noting that she has already had one to my knowledge, and the passage of time. Her diabetic status needs to be checked.
The usual approach to matters such as this is to allow the pain to settle and then to allow physiotherapy to begin. It is most unusual to suggest that manipulation is necessary.”
[55] Reply page 37.
The medical evidence is that the applicant had two steroid injections in her left shoulder but the benefit wore off after 10 days to two weeks. The applicant reported to Dr Hopcroft that she was not making progress with physiotherapy and had ceased that treatment. The applicant’s statement[56] records that she currently takes Panadol, Nurofen and Proxen SR1000. The applicant states she has chronic pain and functional problems in her left shoulder.
[56] Application pages 3-4.
It is apparent from the medical evidence and the applicant’s evidence that the left shoulder condition has not settled by itself and that she has not experienced sustained relief from conservative treatments.
Dr Hopcroft agrees with Dr Young that the proposed surgery is appropriate and is required for the applicant to make any significant progress.
A/Prof Miniter considers the surgery is not recommended for frozen shoulder, however, as previously noted, Dr Hopcroft and Dr Young are in agreement that the applicant’s left shoulder condition involves pathology additional to frozen shoulder.
Having regard to all the evidence, I find that the surgery proposed by Dr Young, being left shoulder arthroscopic release and manipulation + subacromial decompression + distal clavicle excision +/- rotator cuff repair, is reasonably necessary medical treatment as a result of the workplace injury to the right shoulder, pursuant to s 60 of the 1987 Act.
The respondent is to pay the cost of the surgery proposed by Dr Young on 7 September 2023, and associated hospital fees, anaesthetist fees and rehabilitation costs.

SUMMARY

The applicant sustained a consequential condition in her left shoulder as a result of the workplace injury to her right shoulder.
The surgery proposed by Dr Young, being left shoulder arthroscopic release and manipulation + subacromial decompression + distal clavicle excision +/- rotator cuff repair, is reasonably necessary medical treatment as a result of the workplace injury to the right shoulder, pursuant to s 60 of the 1987 Act.
The respondent is to pay the cost of the surgery proposed by Dr Young and associated hospital fees, anaesthetist fees and rehabilitation costs.
The order is set out in the Certificate of Determination.

[2024] NSWPIC 295

3 June 2024