Oakes v PLO Enterprises Pty Ltd - [2024] NSWPIC 204

CERTIFICATE OF DETERMINATION OF MEMBER
CITATION:	Oakes v PLO Enterprises Pty Ltd [2024] NSWPIC 204
APPLICANT:	Lisa Oakes
RESPONDENT:	PLO Enterprises Pty Ltd
MEMBER:	Cameron Burge
DATE OF DECISION:	23 April 2024
CATCHWORDS:	WORKERS COMPENSATION - Alleged consequential condition to accepted injury; whether proposed temporomandibular treatment is reasonably necessary as a result of workplace injury; applicant suffered accepted upper limb and cervical spine injuries; she alleges she suffered a consequential psychological condition which caused bruxism and jaw dysfunction; respondent alleges the jaw symptoms are not causally connected to the accepted injury and the proposed treatment, which is medically necessary, is not reasonably necessary as a result of the workplace injury; Held – causation in the workers compensation context is determined by way of a commonsense evaluation of the causal chain; Kooragang Cement Pty Ltd v Bates applied; an examination of the lay and expert evidence establishes a commonsense causal connection between the accepted injury and the requirement for the proposed treatment; the injury at issue gave rise to an increase in psychological symptoms in the applicant, which in turn occasioned her bruxism for which she seeks treatment; the fact the applicant had previously suffered psychological symptoms is not fatal to her case, as the evidence discloses a worsening of those symptoms post-injury; on balance, the proposed treatment is reasonably necessary as a result of the injury at issue, in that there is a material contribution to the need for the treatment by the injury; respondent to pay the costs of and incidental to the proposed treatment.
DETERMINATIONS MADE:	The Commission determines: 1. The applicant suffered injury in the course of her employment with the respondent, with a deemed date of injury of 18 August 2018. 2. As a consequence of the injury referred to (1) above, the applicant suffered a consequential psychological condition and temporomandibular/jaw condition. 3. The temporomandibular/jaw condition is consequent upon the applicant’s injury. 4. The dental treatment carried out by Dr Curtis in March 2023 was reasonably necessary as a result of the consequential condition caused by the applicant’s injury, save for the occlusal splint therapy which is not part of the claim in these proceedings. 5. The respondent is to pay the costs of and incidental to the claimed treatment carried out in 2023 by Dr Curtis.

STATEMENT OF REASONS

BACKGROUND

The applicant, Lisa Oakes brings proceedings seeking payment by the respondent, PLO Enterprises Pty Ltd for the costs of and incidental to arthrocentesis and manipulation of her left temporomandibular joint carried out by Dr Nigel Curtis in or about April 2023.
The applicant claims the requirement for treatment was brought about as a result of a consequential condition to her jaw caused by sustained bruxism caused by a psychological condition said to have in turn been brought about as a consequence of accepted injuries to her bilateral wrists and shoulders, thoracic spine and cervical spine.
The respondent disputes liability for the applicant’s claim and says there is no causal link between her accepted injuries and…

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 Oakes v PLO Enterprises Pty Ltd

Details

AGLC: Oakes v PLO Enterprises Pty Ltd [2024] NSWPIC 204
Case: [2024] NSWPIC 204
Decision Date: 23 April 2024

CaseChat Overview and Summary

In the matter of Oakes v PLO Enterprises Pty Ltd, the primary dispute was centered around the applicant's claim for compensation for a proposed treatment for temporomandibular dysfunction, which she alleged was a consequence of her accepted workplace injuries. The case was heard in the Workers Compensation Court of New South Wales. The applicant had sustained upper limb and cervical spine injuries in a workplace incident and subsequently claimed that these injuries led to a psychological condition, which in turn caused bruxism and jaw dysfunction. The respondent contested the causal link between the workplace injury and the proposed treatment, arguing that the psychological condition and subsequent bruxism were not a direct consequence of the accepted injuries.

The legal issues before the court were whether the proposed temporomandibular treatment was reasonably necessary as a result of the workplace injury and whether the applicant's psychological condition was causally connected to the injury. The court had to determine if the applicant's condition and the proposed treatment met the criteria for compensation under workers compensation law. The application of the commonsense approach to causation, as established in Kooragang Cement Pty Ltd v Bates, was central to resolving these issues.

The court examined both lay and expert evidence to establish the causal connection between the accepted injury and the proposed treatment. It found that the applicant's injuries had led to an exacerbation of her psychological symptoms, which in turn caused her bruxism. The court concluded that the proposed treatment was reasonably necessary as it was materially contributed to by the workplace injury. The fact that the applicant had experienced psychological symptoms prior to the injury did not negate the causal link, as the evidence showed a worsening of these symptoms following the injury. Consequently, the court ruled in favour of the applicant and ordered the respondent to pay for the costs of and incidental to the proposed treatment.

Orders