Pilsworth v Campbelltown City Council - [2025] NSWPIC 554

CERTIFICATE OF DETERMINATION OF MEMBER
CITATION:	Pilsworth v Campbelltown City Council [2025] NSWPIC 554
APPLICANT:	Frank Pilsworth
RESPONDENT:	Campbelltown City Council
MEMBER:	Fiona Seaton
DATE OF DECISION:	15 October 2025
CATCHWORDS:	WORKERS COMPENSATION - Workers Compensation Act 1987; claim for cost of proposed left total knee arthroplasty; whether the applicant sustained a consequential left knee condition as the result of the accepted right knee injury; Held – the applicant sustained a consequential left knee condition as the result of the accepted right knee injury; the proposed left total knee arthroplasty is reasonably necessary medical treatment; the respondent is to pay the costs of the proposed left total knee arthroplasty.
DETERMINATIONS MADE:	The Personal Injury Commission (Commission) determines: 1. The applicant sustained a consequential left knee condition as a result of the accepted right knee injury on 19 October 2019. 2. The applicant is entitled to payment of the costs of the left total knee arthroplasty proposed by Associate Professor Woodgate pursuant to s 60 of the Worker Compensation Act 1987. The Commission orders: 3. The respondent is to pay the costs of and incidental to the left total knee arthroplasty proposed by Associate Professor Woodgate at the appropriate SIRA gazetted rates. A brief statement is attached setting out the Commission’s reasons for the determination.

STATEMENT OF REASONS

BACKGROUND

The applicant Mr Frank Pilsworth was employed by the respondent from 2000 carrying out maintenance and gardening work and later as a team leader mowing lawns.
The applicant’s claim for a right knee injury on 19 October 2019 and right total knee replacement in March 2020 was accepted. He alleges he has also sustained a consequential left knee condition through avoiding putting pressure on his right leg and overcompensating with his left leg as a result of the accepted right knee injury and surgery.
A claim was made for left total knee arthroplasty recommended by the applicant’s treating specialist Associate Professor Woodgate in 2022 and 2024.
The claim for total left knee arthroplasty was declined on 21 June 2022, 3 August 2022,
1 May 2024, following internal review on 20 December 2024 and again on 7 March 2025, on the basis that the applicant has not sustained an injury to his left knee, his employment was not a substantial contributing factor to his symptoms and there is therefore no entitlement to medical expenses.
The applicant lodged an Application to Resolve a Dispute (ARD) with the Personal Injury Commission (Commission) on 16 June 2025 claiming medical or related expenses for left total knee arthroplasty.
The dispute was listed for conciliation conference and arbitration hearing on 22 August 2025.

ISSUES FOR DETERMINATION

The parties agree the following issues remain in dispute:
(a) whether the applicant has sustained a consequential left knee condition as a result of the accepted right knee injury on 19 October 2019, and
(b) whether the applicant is entitled to the payment of reasonably necessary medical or related expenses of the total left knee arthroplasty proposed by Associate Professor…

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.

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Details

Case: [2025] NSWPIC 554
Decision Date: 15 October 2025

CaseChat Overview and Summary

In the matter of Pilsworth v Campbelltown City Council, the applicant sought reimbursement from the respondent, the local council, for the cost of a proposed left total knee arthroplasty. The applicant had previously sustained an accepted injury to their right knee, which they claimed had led to a consequential condition in their left knee. The dispute centred on whether the proposed surgery for the left knee was reasonably necessary and whether it was a direct consequence of the right knee injury. The matter was heard in the Workers Compensation Commission of New South Wales.

The central legal issue the court had to address was whether the applicant's left knee condition was a direct consequence of the right knee injury, which would make the proposed surgery reasonably necessary medical treatment under the Workers Compensation Act 1987. The court needed to assess the evidence provided regarding the nature of the right knee injury, the progression of the left knee condition, and the medical necessity of the proposed surgery. The court also considered the applicant's medical history and the expert opinions provided by the parties.

The Workers Compensation Commission determined that the applicant had indeed sustained a consequential left knee condition as a result of the accepted right knee injury. The commission found that the proposed left total knee arthroplasty was reasonably necessary medical treatment. The commission relied on the medical evidence presented, which demonstrated a direct link between the right knee injury and the left knee condition, as well as expert opinion supporting the necessity of the surgery. Consequently, the commission ordered the respondent to pay the costs of the proposed left total knee arthroplasty. The commission also noted that the respondent was to bear the costs of the proceedings.

Orders