Smith v Blacktown City Council
[2025] NSWPIC 578
•27 October 2025
| CERTIFICATE OF DETERMINATION OF MEMBER | |
| CITATION: | Smith v Blacktown City Council [2025] NSWPIC 578 |
| APPLICANT: | Terrance Charles Smith |
| RESPONDENT: | Blacktown City Council |
| MEMBER: | Adam Halstead |
| DATE OF DECISION: | 27 October 2025 |
CATCHWORDS: | WORKERS COMPENSATION - Workers Compensation Act 1987; section 60 claim for medical expenses; carpal tunnel syndrome; nature of employment; whether disease injury; whether consequential condition to accepted cervical spine injury; Held – carpal tunnel syndrome not consequential to cervical spine injury; disease injury that developed concurrently with cervical spine injury; proposed treatment is reasonably necessary as a result of the work-related injury; respondent ordered to pay the costs of, and incidental to, the recommended surgery. |
| DETERMINATIONS MADE: | The Personal Injury Commission (Commission) determines: 1. The applicant sustained a disease injury, bilateral carpal tunnel syndrome, in the course of employment with the respondent, which is deemed to have occurred on 11 January 2018. 2. Bilateral staged carpal tunnel release surgery as proposed by Dr Rohit Kumar on The Commission orders: 3. The respondent is to pay the costs of, and associated with, the bilateral staged carpal tunnel release surgery, pursuant to s 60 of the Workers Compensation Act 1987. A brief statement is attached setting out the Commission’s reasons for the determination. |
STATEMENT OF REASONS
BACKGROUND
The applicant, Terrance Charles Smith, was employed by the respondent, Blacktown City Council, as a backhoe operator for about 17 years to October 2019. It was previously determined, by the former Workers Compensation Commission (WCC) on 15 October 2019, that the applicant suffered cervical spine injury in the course of his employment and that surgical treatment be provided. He underwent surgery for that injury on 13 March 2020. The applicant now seeks surgery to treat bilateral carpal tunnel syndrome that is claimed to have arisen as either a consequence of the cervical spine injury or from the nature of his employment, or both. The claim is disputed by the respondent on the basis the surgery is said not to be reasonably necessary as a result of workplace injury.
The applicant commenced proceedings in the Personal Injury Commission (Commission) on 21 July 2025 when an Application to Resolve a Dispute (ARD) was lodged in relation to the disputed claim.
PROCEDURE BEFORE THE PERSONAL INJURY COMMISSION
The matter was before the Commission for arbitration hearing on 12 September 2025. The applicant attended and was represented by Mr King of counsel, instructed by Carroll and O’Dea Lawyers. The respondent was represented by Mr Stiles of counsel, instructed by Sparke Helmore Lawyers, and a delegate of its insurer was present.
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 endeavoured to bring the parties to the dispute to an acceptable settlement and am satisfied that the parties have had sufficient opportunity to explore settlement. They have been unable to reach an agreed resolution of the dispute.
ISSUES FOR DETERMINATION
The applicant sought leave to amend the ARD, which was not opposed by the respondent, so as the surgery sought is “bilateral carpal tunnel release” and that the date of injury be pleaded as the following alternatives, either separately or in combination:
· 11 January 2018 (deemed), on the basis of the determination of the WCC with respect to disease injury of the cervical spine also deemed to have occurred on that date;
· 11 January 2018 (deemed), where carpal tunnel is a condition consequential to cervical spine injury;
· 31 October 2019 (deemed), the applicant’s final day of employment with the respondent, and
· 13 March 2024, the date a request was made for the carpal tunnel release surgery.
Leave was granted and the ARD is taken to be amended accordingly. It is the respondent’s position that the relevant dates would be 11 January 2018 or 31 October 2019 should the applicant’s condition be determined as consequential to cervical spine injury or a disease injury that arose in the course of employment.
The parties request a determination about whether the bilateral carpal tunnel release surgery requested by the applicant is reasonably necessary as a result of workplace injury. In particular, whether the applicant’s bilateral carpal tunnel condition is a disease injury contracted in the course of employment and/or has arisen as a consequence of his cervical spine injury, specifically, the surgery undertaken to treat that injury.
EVIDENCE
The following documents were in evidence before the Commission at the arbitration hearing, without objection, and considered in making this determination:
(a) ARD and attached documents of 114 pages;
(b) Reply and attached documents of 181 pages (Reply);
(c) Application to Lodge Additional Documents made by the respondent on
29 August 2025 with attached documents of 628 pages (ALAD-R), and(d) Application to Lodge Additional Documents made by the applicant on
5 September 2025 with attached documents of 2 pages (ALAD-A).There was no application to call oral evidence or cross-examine any witness at the hearing.
Applicant’s statement evidence
The applicant relies on four statements, dated 22 January 2018, 18 July 2019,
7 November 2024 and 30 July 2025, that were prepared in relation to the current disputed claim for compensation and his prior claim for cervical spine injury.The nature of his work as a backhoe operator for the respondent is described by the applicant as him having spent about 95% of the time operating the machine, being heavily jolted and jarred through forwards, backwards and sideways movements with constant shuddering and vibration.[1]
[1] ARD p 1 at [3].
According to his first statement an incident occurred on 15 January 2003 that involved his head striking the cabin ceiling of the backhoe he was operating at the time when it “hit [a] speed bump” and he became “aware of numbness in both … hands” afterwards.[2] The applicant recalls that “a few years” after that incident there was “numbness and tingling” in his hands and that “as time went by … the numbness in [his] hands and tingling was also more noticeable”.[3]
[2] ARD p 2 at [4].
[3] ARD p 2 at [5] and [7].
At the time of making his 18 July 2019 statement, the applicant had ongoing “numbness and tingling to both hands”.[4] His more recent evidence, as recounted in the 7 November 2024 statement, is that:[5]
“Over many years of my employment with the [respondent] as an operator, I worked in cold environment [sic] and in machinery that heavily vibrated me constantly throughout the day… The machine that I drove had controls being a joystick which I operated with both hands and so my hands were constantly being vibrated whilst in the course of my work over many years.
It is hard for me to recall exactly when I first noticed symptoms of numbness and tingling and pain in my hands. I can say they weren’t present before the 2002 injury. However I certainly recall the symptoms …. following this injury.”
[4] ARD p 4 at [5].
[5] ARD p 5 at [7] and [8].
It is noted that statement refers to an injury on 15 January 2002. There appears to be a typographic error with respect to the date, which presumably should read 15 January 2003 given the content of his earlier statement made on 22 January 2018. There is no evidence of a 2002 injury, which was before his employment commenced with the respondent during December 2002. The 22 January 2018 statement also refers to not having suffered any injury “prior to 16 January 2003”, which would exclude the incident described in detail said to have occurred on 15 January 2003. That date reference also appears to be an error. When the statement evidence is read as a whole, it appears the only relevant incident is that described for 15 January 2003 when the applicant struck his head on the cabin ceiling of the backhoe he was operating at the time.
The latest statement evidence provided by the applicant, on 30 July 2025, is that he “continue[s] to experience numbness in the fingers” as well as pain in the knuckles and restricted use of his hands, including difficulty with grip strength.[6]
[6] ALAD-A p 1 at [2].
Dr Rohit Kumar
The applicant was referred to receive specialist treatment from Dr Rohit Kumar, plastic, reconstructive and hand surgeon. In his 25 July 2024 report, Dr Kumar diagnosed the applicant with “features clinically consistent with Bilateral Carpal Tunnel Syndrome” that had been “confirmed by nerve conduction studies and evidence of pathology at C5, C8 segments”. He reported that:[7]
“Bilateral Carpal Tunnel Syndrome can have a more central cause (c-spine) as is evidenced by this study.
[The applicant] has had cervical spine surgery under Workcover. It is thus quite feasible for the carpal tunnel syndrome (bilaterally) to be exacerbated or a secondary consequence of the primary c-spine injury and therefore, this injury would be the main contributing factor.
Given the significant levels of symptoms experienced by [the applicant], the carpal tunnel release procedures are more than reasonably necessary for him.”
[7] ARD p 35.
Associate Professor Brett Courtenay
Associate Professor Brett Courtenay, orthopaedic surgeon, was qualified by the applicant to conduct an independent medical examination. In relation to the applicant’s history, it was reported on 3 October 2024 that:[8]
“He has always had problems with numbness in his hands but that really did not improve after he had his neck operated on. That was a single level cervical fusion at C3/4 done on 13 March 2020 at Westmead Private Hospital. Subsequent to that he has had his left shoulder operated on, on 5 October 2022. He has noticed however despite some initial improvement after his neck fusion that his hands became progressively worse. He has had a lot of problems with his left hand more than the right though he is right hand dominant.”
[8] ARD p 38.
Associate Professor Courtenay formed the opinion that the applicant’s:[9]
“…wrists carpal tunnel syndrome, the left worse than the right are a direct consequence of the type of work he was doing and the length of time he was doing it. There was certainly in the work he as doing a significant amount of vibration. There is some question in the American Guidelines of causation about whether or not repetitive use causes it, however there is a lot of evidence to support the quite consistent vibration is a very causative factor and even now when he uses the whipper snipper it is a factor that aggravates. So for that reason it is certainly my opinion that his carpal tunnel syndrome is directly related to the type of work he was doing, the vibrations and the use of the joysticks and that he was doing that for a period of 18 years. Also carpal tunnel syndrome in men who are not doing this type of work is generally very unusual and certainly is consistent as I believe it is related to the work that he was doing.”
[9] ARD p 40.
In response to specific questions, Associate Professor Courtenay rejoined:[10]
“… the nature and conditions of his employment, particularly the use of a backhoe, particularly the amount of work involved with rock crushing to represent the main contributing factor to the development and to the aggravation of underlying carpal tunnel syndrome of both wrists the left worse than the right.
…
I do not believe it is a secondary consequence of any primary injury to his cervical spine. It is the cervical spine sensory for carpal tunnel is different levels. For that reason I do not believe that it is directly related however as the cervical spine came about with the use of the backhoe and its aggravation of pain I believe this was happening at the same time and there has been a sequential injury for the same reasons as his neck and the same reason he had his left shoulder operated on.”
[10] ARD p 41.
A supplementary report was provided by Associate Professor Courtenay on 4 March 2025, wherein he opined:[11]
“I note the comments there that there is a comment it came from the cervical spine. Technically and anatomically I would not expect that. I think it is far more likely that the carpal tunnel was a separate condition and most definitely related to the gripping of the equipment to the work that he was doing and the repeated physical activities. There is always some debate about what is actually a cause of carpal tunnel. It is less likely in men than in women but it certainly can be from constant pressure over the wrist and certainly the work that he was doing, the jarring of the equipment in my opinion would certainly be consistent with that occurring.
So for that reason I do believe that it is appropriate for him to be considered and I do believe that the bilateral carpal tunnel releases are reasonably necessary for the work related condition. It is just that I think it is associated but secondary and due to the nature and conditions of his employment and it has been aggravated and failed to respond from his cervical surgery.”
[11] ARD p 43.
Dr Bhisham Singh
The orthopaedic and spine surgeon attending to the applicant’s cervical spine injury,
Dr Bhisham Singh, reported to the treating general practitioner on 16 October 2023 that:[12]“He has ongoing symptoms of numbness in the hands, and as you know, he has disease in the cervical spine. He has previously had C3-4 ACDF, and has had decompression there. He does have disease lower down with foraminal stenosis. This is likely responsible for pins and needles in his hands, however, he does have positive Tinel’s sign at the wrist, worse on the right side, and it is important to rules out carpal tunnel syndrome before we proceed with his surgical option of further cervical spine surgery.”
[12] ARD p 67.
Dr Singh noted during a consultation on 16 May 2017 the applicant with prior “pins and needles and numbness in his hands for quite some time” but those had “abated recently”.[13]
[13] ARD p 44.
Dr Roger Rowe
The respondent qualified Dr Roger Rowe, orthopaedic surgeon, to conduct an independent medical examination of the applicant. Dr Rowe provided reports on several occasions, initially with respect to the applicant’s cervical spine and more recently focussed on issues associated with the current dispute. Some of the earlier reports are however pertinent as they contain relevant history, such as that of 26 February 2018, prior to the applicant’s cervical spine surgery on 13 March 2020, when it was recorded the applicant:[14]
“… said that he has a tingling sensation in the right side of the neck and supraclavicular region. This may radiate to both hands especially to the middle fingers and especially at night. He is able to relieve this sensation by moving his fingers.”
[14] Reply p 18.
On 27 October 2021, in referring to the applicant’s history and “current status”, Dr Rowe noted, referring to his left arm, the applicant had:[15]
“… pins and needles in the middle and ring fingers on an intermittent basis. This seems to occur mainly when lying on his left side. He said that after his relatively recent one hour lawn mowing session, he developed pins and needles in both hands for a while.”
[15] Reply p 27.
With respect to the applicant’s then current treatment and status two years later, Dr Rowe reported on 25 October 2023 that:[16]
“He last consulted Dr Singh a couple of weeks ago. He said that Dr Singh has requested some electrical tests to establish whether his current sensory symptoms in both hands are the result of carpal tunnel syndrome or are arising from the neck.
…
He said that both hands have pins and needles and numbness in the ulna three digits. These symptoms occur on an intermittent basis. The symptoms may occur at any time whether he is in bed or with sitting and especially when mowing the lawn or operating a whipper snipper. He clarified that he does not have the sensory symptoms in the thumb or index finger of either hand.”
[16] Reply pp 53 to 54.
In the same report, Dr Rowe opined:[17]
“Mr Smith has already undergone C3/4 discectomy and fusion. His current symptoms seemed to be largely related to pins and numbness and numbness in both hands, the precise cause of which is yet to be determined. Mr Smith is under the impression that it may be carpal tunnel syndrome but this is unlikely as it is the ulnar side fingers that are affected rather than the median side fingers.
He indicated that electrophysiological studies have been requested and this is reasonable to clarify the diagnosis. If the diagnosis is simply carpal tunnel syndrome or compression of the ulnar nerve at the wrist, this is easily released surgically. If the symptoms are not related to peripheral nerve compression, the symptoms may well be arising from the neck. It is noted quotations for proposed extensive cervical spinal surgery.”
[17] Reply p 56.
In a secondary report of 25 October 2023, Dr Rowe considered that:[18]
“As noted in my main report of even date, Mr Smith is currently being further investigated with electrophysiological studies. If these electrophysiological studies demonstrate significant carpal tunnel compression, then this should be treated surgically and presumably cure the condition. Surgical treatment on the cervical spine should not even be actively considered until the precise location of origin of the symptoms has been determined. Extensive cervical spinal fusion will make no difference to carpal tunnel syndrome. On this basis, at the moment, the proposed extensive surgical treatment on the cervical spine is not reasonably necessary.”
[18] Reply p 60.
Supplementary reporting of Dr Rowe on 23 April 2024 was that the applicant:[19]
“… has pins and needles affecting the ulnar three digits. Whether these are arising from the neck is uncertain as they are not a reflection of carpal tunnel syndrome.”
[19] Reply p 64.
He opined that:[20]
“Bilateral carpal tunnel release has been proposed, presumably with the support of the electrophysiological examination which has been referred to by Dr Singh and Dr Kumar. Dr Singh mentioned that this condition was found to be severe on the left side and slightly less severe on the right side. The actual report of the electrophysiological examination was not available. An unusual feature is that whilst the electro-physiological examination apparently indicates carpal tunnel syndrome, his symptoms are in the ring and little finger which are not supplied by the median nerve.
Overall, it is my assessment that he would be better avoiding further surgery and thus overall, I would consider bilateral carpal tunnel release not reasonably necessary.
Notwithstanding my comments above, if Mr Smith is significantly troubled by paraesthesia in his hands, it may be worthwhile allowing bilateral carpal tunnel release in the hope that it would alleviate his symptoms. If it was to alleviate his symptoms, he may not require cervical spinal surgery. Nevertheless, I would not be confident in this regard.
….
As indicated above, it is my opinion that he would probably be better off avoiding bilateral carpal tunnel release but if it is accepted that this treatment was to be undertaken, I do not see any nexus between the need for such surgery and his employment. It is also noted that he has not undertaken any work for around four and a half years since he ceased working on 31 October 2019.”
[20] Reply pp 68 and 69.
CONSIDERATION AND FINDINGS
The applicant’s case is pleaded and argued with reference to various dates and in several alternatives or combinations of events. He need only establish one of those for the application to succeed. For the reasons that follow, I am satisfied the applicant sustained a disease injury to his wrists in the course of employment with the respondent.
Consequential condition
Although it is therefore unnecessary to consider the various alternatives argued by the applicant, the claim of a consequential condition arising from cervical spine injury following surgery is nonetheless relevant for brief examination.
As submitted by the respondent, the applicant had been complaining of symptoms with his hands for some time. Reference was made to 2017 as an early date, however the applicant himself refers to relevant symptoms “a few years after” the incident on 15 January 2003. He also makes reference to his hands being affected on the occasion of that incident. The reporting of Associate Professor Courtenay and Dr Rowe refers to the presence of symptoms prior to the surgery. There is substantial evidence the applicant experienced symptoms relevant to the condition for which surgery is sought well before the cervical spine surgery on
13 March 2020. It is a condition that could not have been consequential to that surgery in those circumstances.It is noted Dr Kumar thought it “feasible for the carpal tunnel syndrome (bilaterally) to be exacerbated or a secondary consequence” of the cervical spine surgery, but he did not provide an explanation for that opinion or describe any mechanism by which that may have occurred. The timing of the surgery discounts it being a “secondary consequence” and while exacerbation may be relevant, that assumes prior existence of the condition. Associate Professor Courtenay decisively rejected the proposition of the condition being consequential to the surgery, although he did accept there may have been some aggravation; again prior existence is relevant. On the available evidence, I consider it unlikely the condition affecting the applicant’s wrists was a consequence of his cervical spine injury and related surgery.
Disease injury
Section 4(b)(i) of the Workers Compensation Act 1987 (the 1987 Act) provides that a disease that is contracted by a worker in the course of employment is “disease injury” if employment was the main contributing factor. In AV v AW [2020] NSWWCCPD 9, Snell DP reviewed various prior presidential determinations about the meaning of “main contributing factor” and identified that it “involves consideration of whether there were competing causal factors” for a disease injury.
The applicant contends the work he performed as a backhoe operator was the main factor that caused the bilateral carpal tunnel condition. His statement evidence outlines in detail the type of work he performed daily and the persistent exposure to “jarring” in the machine as well as vibration using controllers, “joysticks”, to operate the backhoe apparatus.
The respondent’s submissions were mainly directed at the applicant’s condition not being a consequence of cervical spine injury. I accept that premise. The reasonable necessity for the treatment as a result of workplace injury was nonetheless disputed.
Referring to the nature of the applicant’s work, Associate Professor Courtenay considered the wrist condition to be directly related to his employment given the requirement to grip joysticks, with the associated vibration, over 18 years and repeated physical activity. He thought the constant jarring and pressure on the applicant’s hands were the most likely cause of the condition which he thought to be an unusual diagnosis for a male. In refuting the suggestion the condition was consequential to the applicant’s cervical spine injury, Associate Professor Courtenay reasoned that the conditions had developed concurrently but presented sequentially. Although he did accept, consistent with the view of Dr Kumar, that the cervical spine surgery may have “aggravated” the wrist condition. He did not identify any likely cause for the applicant’s carpal tunnel syndrome other than employment with the respondent.
Dr Rowe did not conclusively assess the applicant with carpal tunnel syndrome, but he accepted if that were the diagnosis then it could be “easily released surgically”. Should it be present, Dr Rowe considered it “should be treated surgically and presumably cure the condition”. He accepted carpal tunnel release surgery may avoid the need for the applicant to have further cervical spine surgery. However, he thought there was no “nexus” between the applicant’s need for carpal tunnel surgery and his employment, without further explanation.
The nature of the applicant’s work functions is not in dispute. His hands and wrists were subjected to persistent physically demanding activity over many years. The extent of any effect or contribution from the incident on 15 January 2003 is unclear, but it would in any case have occurred in the course of his employment. The cogent opinion of Associate Professor Courtenay provides a causal connection between his backhoe operating duties and the applicant’s carpal tunnel syndrome. He referred to medical evidence that links “consistent vibration” with carpal tunnel syndrome as a cause. I am reasonably satisfied that his medical opinion establishes, on balance, that the nature of the applicant’s physical work was the most likely cause of the condition.
There is no evidence the applicant engaged in other activities during the relevant period that may have contributed to, or caused, the condition. In the circumstances, the applicant’s work is more likely than not the main factor that contributed to the condition in his wrists. I am satisfied carpal tunnel syndrome developed over a period of time in the course of the applicant’s employment. Accordingly, it is accepted as a disease injury for the purposes of s 4(b)(i) of the 1987 Act.
It was previously determined by the WCC that the applicant’s cervical spine injury was deemed to have occurred on 11 January 2018. There is no reason the date the applicant’s carpal tunnel syndrome is deemed to have occurred should be different. Associate Professor Courtenay considered those injuries developed “at the same time”. The medical records leave no doubt the applicant had symptoms of the condition on that date. It is reasonable for that date to be accepted in circumstances where the applicant had been reporting it to medical practitioners as a symptom resulting in some degree of incapacity to his hands and wrists, such a continuing numbness, albeit not always at the same level of intensity. It is noted the respondent accepted that if the nature of employment was found to be the cause of the applicant’s injury then the date adopted by the WCC would be relevant. The applicant’s carpal tunnel syndrome disease injury is deemed to have occurred on 11 January 2018.
Reasonably necessary
Section 60 of the 1987 Act provides for the reasonably necessary treatment of workplace injury. The applicant has the onus to establish, on the balance of probabilities, the provision of surgery is reasonably necessary as treatment for his carpal tunnel syndrome. I must have a “a sense of actual persuasion” that the reasonable necessity exists and that it results from the injury as claimed: Nguyen v Cosmopolitan Homes Pty Ltd [2008] NSWCA 246 and Yucel v AAES Pty Ltd t/as Roadtrack [2015] NSWWCCPD 51.
The concept of reasonable necessity of a particular treatment was considered by Roche DP in Diab v NRMA Ltd [2014] NSWWCCPD 72 (Diab). The fundamental question: “is it better that the worker have the treatment or not?” That is, are there reasonable prospects that the worker’s situation will be improved or ameliorated by the treatment.
It was made clear by Roche DP, citing various authority, in Murphy v Allity Management Services Pty Ltd [2015] NSWWCCPD 49 (Murphy) that in order to satisfy the test of causation implied by the expression “result of”, it is not necessary to establish the work injury was the only, or even a substantial, contributing factor to the need for medical treatment. It is sufficient to establish only that the injury “materially contributed”.
A commonsense examination of the causal chain is required to determine whether the need for the claimed treatment arises as a result of the work-related injury: Kooragang Cement Pty Ltd v Bates (Kooragang).[21] The applicant is not required to prove the requested surgery is absolutely necessary, only that it be reasonably so: Diab.
[21] Kooragang Cement Pty Ltd v Bates (1994) 10 NSW CCR 796.
In summary, I must determine whether it is reasonable and preferable for the applicant to have the surgery requested. In making that determination, relevant considerations include the suitability of the treatment, availability of alternative treatment (and the potential effectiveness of those), cost of the proposed treatment, potential effectiveness of the proposed treatment and the acceptance by medical experts of the treatment as being appropriate and likely to be effective.[22]
[22] Rose v Health Commission (NSW) [1986] NSWCC 2 (Rose).
I am reasonably satisfied that the applicant’s employment has materially contributed to the need for surgery: Murphy. This is made clear in the various medical opinion, which is generally consistent about the need for the proposed surgery. Even though Dr Rowe suggests it would be better for the applicant to avoid surgery, he considered that if the applicant were to be “significantly troubled by paraesthesia in his hands” then “it may be worthwhile allowing bilateral carpal tunnel release in the hope that it would alleviate his symptoms”. The applicant’s most recent statement confirms the condition remains a concern and has “worsened”. His treating doctors and the independent medical examiners concur the proposed surgery is an appropriate form of treatment to treat carpal tunnel syndrome. According to Dr Singh, carpal tunnel release is necessary prior to any further cervical spine surgery, which has been under active consideration given ongoing problems with that injury.
I have weighed the matters identified in Rose and consider the evidence supports a finding the proposed treatment is reasonably necessary in the circumstances for the purposes of
s 60 of the 1987 Act. On balance it is better than not for the treatment to proceed. Accordingly, the respondent is liable to meet the cost of the surgical treatment recommended by Dr Kumar in his letters dated 6 and 13 March 2024,[23] that is, “bilateral staged carpal tunnel release”.[23] ARD pp 32 and 33.
SUMMARY
The applicant sustained a disease injury to his wrists, carpal tunnel syndrome, in the course of employment with the respondent over several years that is deemed to have occurred on 11 January 2018. He is entitled to the cost of and incidental to surgery to treat the injury.
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