Tika v Trucking Specialist Group Pty Ltd ATF
[2025] NSWPIC 552
•15 October 2025
| CERTIFICATE OF DETERMINATION OF MEMBER | |
| CITATION: | Tika v Trucking Specialist Group Pty Ltd ATF [2025] NSWPIC 552 |
| APPLICANT: | Robert Tika |
| RESPONDENT: | Trucking Specialist Group Pty Ltd ATF |
| MEMBER: | Adam Halstead |
| DATE OF DECISION: | 15 October 2025 |
CATCHWORDS: | WORKERS COMPENSATION - Workers Compensation Act 1987; undisputed workplace injury; claim for lump sum compensation; section 66 of the Act; medication prescribed for conditions accepted as caused by workplace injury; gastrointestinal condition; whether consequential to workplace injury as a consequence of using prescribed medication; conflicting opinion from independent medical examiners; delayed onset of condition considered; cigarette smoking considered as other possible cause; Held – prescribed medication most likely cause of gastrointestinal condition; accepted as consequential to workplace injury due to prescribed medication; referral to medical assessor for assessment of whole person impairment. |
| DETERMINATIONS MADE: | The Personal Injury Commission (Commission) determines: 1. The applicant suffers a consequential gastrointestinal condition that arose from injury sustained on 5 November 2018. The Commission orders: 2. The matter is remitted to the President for referral to a Medical Assessor, to be selected by the President, for assessment of the following that arise from injury on 5 November 2018: · right upper extremity (right shoulder); · spine (cervical); · respiratory system; · visual system, and · digestive system (gastrointestinal). 3. The documents to be reviewed by the Medical Assessor are: (a) the Application to Resolve a Dispute and attached documents; (b) the respondent’s Reply and attached documents; (c) the applicant’s Application to Lodge Additional Documents dated 8 August 2025 with attachment; (d) report of Dr Anthony Greenberg, dated 21 August 2025, and (e) this Certificate of Determination with reasons. A brief statement is attached setting out the Commission’s reasons for the determination. |
STATEMENT OF REASONS
BACKGROUND
The applicant, Mr Robert Tika, claims lump sum compensation based on permanent impairment from workplace injury on 5 November 2018. Various conditions are said to arise from that injury, most of which are uncontroversial. These proceedings are about whether the applicant suffered a consequential gastrointestinal condition. He claims medication prescribed to treat conditions arising from the injury has caused the gastrointestinal condition. The claim is disputed by the respondent, Trucking Specialist Group Pty Ltd.
An Application to Resolve a Dispute (ARD) was made to the Personal Injury Commission (Commission) on 23 June 2025 on whether the applicant’s gastrointestinal condition is consequential to injury accepted as work-related.
PROCEDURE BEFORE THE PERSONAL INJURY COMMISSION
The matter was before the Commission for arbitration hearing on 22 August 2025. The applicant attended and was represented by Mr Tanner of counsel, instructed by Turner Freeman Lawyers. The respondent was represented by Ms Goodman of counsel, instructed by Bartier Perry 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 parties request referral of the matter to a Medical Assessor for assessment of the applicant’s permanent impairment after a determination is made about whether the applicant suffers a gastrointestinal condition consequential to workplace injury on 5 November 2018.
EVIDENCE
The following documents were in evidence before the Commission at the arbitration hearing, without objection, and considered in making this determination:
(a) ARD with attachment of 306 pages;
(b) Reply with attachment of 213 pages (Reply);
(c) Application to Lodge Additional Documents (ALAD) made by the respondent on
8 August 2025 with a three-page annexure (ALAD-1), and(d) Supplementary report of Dr Anthony Greenberg of three pages, dated 21 August 2025, received at hearing on 22 August 2025 (Greenberg-3).
There was no application to call oral evidence or cross-examine any witness at the hearing.
Applicant’s statement evidence
In his statement dated 13 May 2025[1] the applicant recounts the circumstances of his injury on 5 November 2018 and of being prescribed medication for pain relief. He refers to prescriptions for Panadeine Forte, Endep, Imovane, Diazepam and Palmitoylethanolamide.[2] His evidence about the use of medication is undisputed.
[1] ARD, p 2.
[2] ARD, pp 3 and 44 at [25] and [33].
Dr Anthony Greenberg
The applicant qualified Dr Anthony Greenberg, general and gastrointestinal surgeon, to conduct an independent medical examination. In his report of 3 May 2024,[3] Dr Greenberg recorded the applicant as having been in good health, leading an active lifestyle, and with no gastrointestinal problems, prior to his workplace injury. Current medications were listed as Panadeine Forte, Valdoxan, PEA (Palmitoylethanolamide), Nexium, Valium and Zopiclone. It was noted Endep had ceased, Sertraline had been switched to Valdoxan and Celebrex was stopped due to adverse side effects.
[3] ARD, p 92.
In his medication review of the prescriptions, Dr Greenberg remarked that “Panadeine Forte is known to cause a disturbance of gastrointestinal motility and as consequence resulting in a delay of gastric emptying”. He noted Valium (Diazepam) was recognised for adverse gastrointestinal events, for which “frequency was not defined and may vary by route of administration”, such as “[a]ltered salivation [dry mouth or hypersalivation], constipation, diarrhea and nausea. Zopiclone was also noted to have adverse gastrointestinal effects, including anorexia, coated tongue, constipation, diarrhea, dysgeusia [distorted taste], halitosis, increased appetite, nausea, sialorrhea [excess saliva], vomiting and xerostomia [dry mouth]”.[4]
[4] ARD, pp 94 and 95.
Dr Greenberg recorded the applicant with “reflux” in his upper gastrointestinal tract for which a detailed description of symptoms was provided, and the applicant reported the intensity of that aspect of the condition as 7/10 on average but increasing to 9/10 on “4-7 nights of the week”. With reference to the lower gastrointestinal tract, numerous symptoms were outlined that included abdominal cramp pain, toileting urgency, constipation and explosive diarrhea where the applicant has described his bowels as “never normal” with self-reporting of symptoms from “7 to 8/10” on average.[5]
[5] ARD, p 96.
In reaching his conclusion, Dr Greenberg formed the opinion that applicant has gastro-oesophageal reflux disease (GORD), probable analgesic gastropathy and medication-induced gastrointestinal motility disorder. He noted Panadeine Forte as being “recognised to alter gastrointestinal motility” and the applicant’s “symptoms and clinical examination are consistent”.[6] He identified Valdoxan as a cause of “adverse gastrointestinal events” and commented that a “normal colonoscopy does not exclude a medication-induced gastrointestinal motility disorder and is used to exclude organic pathology”. Dr Greenberg was of the view the applicant probably does not have an irritable bowel syndrome.[7]
[6] ARD, p 97.
[7] ARD, p 98.
Dr Greenberg considered that given the applicant required the medications for treatment of pain and a mood disorder, it was “unlikely his gastrointestinal symptoms will settle”. He thought the applicant to be “in a difficult situation” given the need for pain relief but that the treatment by the prescribed medications was the likely cause of “significant adverse gastrointestinal events”.[8] He considered the applicant to have “developed significant gastrointestinal tract dysfunction” as a consequence of the “medication regime” prescribed as treatment for the workplace injury.[9]
[8] ARD, p 104.
[9] ARD, p 106.
Supplementary reports, dated 17 June 2025[10] and 21 August 2025,[11] were also provided by Dr Greenberg, the content of which were responsive to reports provided by the independent medical examiner arranged by the respondent, Dr Sethi. His responses addressed the suggestion he did not have the necessary expertise to comment on the applicant’s case.
Dr Greenberg also considered that while the applicant’s cigarette smoking may have been an aggravating factor, it would not have been the cause of GORD.[12][10] ARD, p 111.
[11] Greenberg-3.
[12] Greenberg-3, p 2.
Dr Siddarth Sethi
Dr Siddarth Sethi, gastroenterologist and hepatologist, was qualified by the respondent to conduct an independent medical examination of the applicant. In his 3 September 2024 report, Dr Sethi referred to the applicant’s injury history, and that analgesia was prescribed for pain management. He recorded the applicant “smokes 5 to 10 cigarettes daily” and that “in early 2021” he:[13]
“… developed a retrosternal burning sensation radiating upwards. This was treated with Nexium. Bowel habits became irregular with alternating diarrhoea and constipation. When he had diarrhoea, he would pass around 4 to 6 loose motions daily. While constipated, he would not open his bowels for 2 days at a time. There was a feeling of incomplete evacuation where he felt that he was not fully emptying his bowels. This was treated with Movicol. The predominant pattern was diarrhoea with a 70% predominance. There was sharp stabbing pain in the abdomen, excess gas/wind and he noted small amounts of bright red rectal blood.”
[13] Reply, p 37.
Medication was reported to be Imovane, Valium, Panadeine forte, Effexor, PEA, Lacritec, Nexium and Nurofen. Current symptoms were “retrosternal burning sensation radiating upwards, irregular bowel habits with predominant diarrhoea, abdominal pain and excess gas/wind … persisting”.[14] Dr Sethi opined that the applicant:[15]
[14] Reply, p 38.
[15] Reply, p 39.
“…blames the analgesic medications that he was prescribed for his work injury for causing him to develop gastrointestinal symptoms.
I disagree with this. In my opinion, he has developed gastro-oesophageal reflux disease (GORD) and irritable bowel syndrome (IBS) entirely of his own accord and his employment, work injury and the analgesic medications that he was prescribed did not play any causative role whatsoever. It has occurred regardless. I shall detail my reasoning below.
His original work injury did not directly involve the gastrointestinal tract.
His description of retrosternal burning sensation radiating upwards is strongly suggestive of GORD. This is a common condition affecting around 15% to 20% of the population and is caused by laxity of the gastro-oesophageal sphincter valve. This is accepted widespread medical and scientific opinion.
Mr. Tika’s smoking has likely significantly contributed to his GORD. Smoking is well described in the medical and scientific literature to worsen GORD.
His description of irregular bowel habits with predominant diarrhoea, abdominal pain and excess wind/gas is strongly suggestive of IBS. This is a common condition affecting around 15% to 20% of the population and is caused by visceral hypersensitivity of the gastrointestinal tract. This is accepted widespread medical and scientific opinion.
His smoking has likely significantly contributed to his IBS. Smoking is well described in the medical and scientific literature to worsen IBS.
The analgesic medications that he was prescribed do not reasonably account for his gastrointestinal symptoms. I note that there was a time gap of 2 years between him being prescribed analgesic medications and developing gastrointestinal symptoms. This is a prolonged period of time and essentially excludes any causative role. Had they been responsible, one would have reasonably expected his symptoms to have started soon after being prescribed medications.
I note that he had irregular bowel habits with predominant diarrhoea. Analgesic medications can cause constipation but do not usually cause diarrhoea. This essentially excludes any causative role for his medications.
…”
Dr Sethi was emphatic that “no condition from which the [applicant] suffers with respect to his digestive system results from the ingestion of medication for treatment of injuries suffered on 5 November 2018”.[16] He diagnosed the applicant as having:[17]
“… developed GORD and IBS entirely of his own accord and his employment, work injury and the analgesic medications that he was prescribed did not play any causative role whatsoever. They have occurred regardless. His smoking has significantly contributed to his GORD and IBS.”
[16] Reply, p 41.
[17] Reply, p 40.
It was also proferred that:[18]
“The analgesic medications that he was prescribed do not reasonably account for his gastrointestinal symptoms. I note that there was a time gap of 2 years between him being prescribed analgesic medications and developing gastrointestinal symptoms.This is a prolonged period of time and essentially excludes any causative role. Had they been responsible, one would have reasonably expected his symptoms to have started soon after being prescribed medications.
I note that he had irregular bowel habits with predominant diarrhoea. Analgesic medications can cause constipation but do not cause diarrhoea. This essentially excludes any causative role for his medications.”
[18] Reply, p 42.
Dr Sethi then went on in his report to impugn the qualification of Dr Greenberg to provide expert opinion on the applicant’s condition and disputed the “diagnosis of a medication induced motility disorder” made by that specialist. He considered Dr Greenberg to have “not reasonably considered the far more realistic and likely probability that he has developed GORD and IBS of his own accord”.[19] He was also of the view that Dr Greenberg had:[20]
“… not considered the prolonged 2 year time gap between [the applicant] being prescribed analgesic medications and subsequently developing gastrointestinal symptoms. He has not reasonably considered the contribution of his smoking to his symptoms.”
[19] Reply, p 43.
[20] Reply, p 43.
A supplementary report dated 31 July 2025 was provided by Dr Sethi that essentially reiterated the findings made in his original report and repeated his criticism of
Dr Greenberg’s opinion, as well as on that specialist’s qualification to comment.
CONSIDERATION AND FINDINGS
The applicant’s claim is relatively straighforward; the various medications he was prescribed to treat his workplace injury were a material cause of a gastrointestinal condition, which had not previously been present. It is therefore said to be consequential to an accepted injury. He bears the onus to prove it is so by establishing that it was more probable than not that his gastrointestinal condition arose from accepted injuries: Drca v KAB Seating Systems Pty Ltd.[21] I am required to have a “feeling of actual persuasion” the applicant has met this onus: Nguyen v Cosmopolitan Homes.[22]
[21] Drca v KAB Seating Systems Pty Ltd [2015] NSWWCCPD 10.
[22] Nguyen v Cosmopolitan Homes [2008] NSWCA 246.
It is not necessary for the applicant to satisfy the requirement of having suffered “injury” for the purposes of s 4 of the Workers Compensation Act 1987 for a consequential condition to be found: Kumar v Royal Comfort Bedding Pty Ltd.[23] He is required only to establish the symptoms associated with the gastrointestinal condition have arisen from other, work-related, injury: Moon v Conmah Pty Limited.[24]
[23] Kumar v Royal Comfort Bedding Pty Ltd [2012] NSW WCCPD 8.
[24] Moon v Conmah Pty Limited [2009] NSWWCCPD 134.
It is also unnecessary for specific pathology to be identified when finding a consequential condition exists,[25] however there must be an unbroken chain of causation from the accepted injury to the development of the consequential condition. A commonsense approach is to be applied to determine causation: Kooragang Cement Pty Ltd v Bates.[26]
[25] Kumar at [55].
[26] (1994) 35 NSWLR 452.
The essential question is whether the workplace injury materially contributed to the condition now claimed by the applicant to be a consequence of that injury: Murphy v Allity Management Services Pty Ltd.[27] To answer that, it must be determined whether the medication prescribed for the applicant to treat the pain and other effects of his injuries made a material contribution to the development of his gastrointestinal condition.
[27] [2015] NSWWCCPD 49 at [56].
The medications prescribed and the reason for them is not disputed. It is also uncontroversial that he has the claimed gastrointestinal condition (although there is some dispute about the precise diagnoses). The applicant contends the use of the medications is a not insignificant factor in its origin. The respondent argues the condition arose for other reasons.
The dispute requires examination of the contest between the independent medical examiner opinion. For the applicant, Dr Greenberg is of the view that his gastrointestinal condition is a consequence of the medication prescribed for the treatment of the pain and other effects related to workplace injury. Dr Sethi considers the condition to have other origins, including smoking, and that it is unrelated to the use of prescribed medications.
The respondent referred to the “many points of difference” between the opinions of the two medical experts but accepts the potential effect of the prescribed medications may be relevant. Notwithstanding that, the delay noted by Dr Sethi is most important. That is, the applicant is said to have told Dr Sethi of related symptoms being present from early 2021, where workplace injury occurred in late 2018. The intervening two-year period is significant, according to the respondent, because symptoms related to the use of medication would be expected to arise soon after initial prescription. The respondent argues the delay is too great, a submission based upon Dr Sethi’s opinion. It is ostensibly an appropriate and reasonable contention.
However, the applicant’s treating general practitioner (GP), Dr Samy Erian, recorded the applicant as having gastrointestinal symptoms during March 2019,[28] which was within a period of around between four and eight weeks of him being prescribed Panadeine Forte on 31 January 2019.[29] His food intake was noted as being unchanged at the time, presumably diet can therefore be discounted as a likely cause of those symptoms at the time. “Hiccups” were later noted when a prescription for Maxolon was made by the GP on 20 May 2019,[30] which is medication used for gastro-intestinal symptoms such as nausea and vomiting.
[28] Reply, p 55.
[29] Reply, p 48.
[30] Reply, p 53.
Valium was added as a prescription to the applicant’s treatment regime by the GP on
13 June 2019.[31] “PUD [peptic ulcer disease] or gastritis for Naprosyn” and constipation were recorded by the GP on 14 January 2020 where the applicant had complained of a week-long episode of “epigastric pain with food” as well as “bloating and passing hard stool” with an occasion of rectal bleeding.[32] Epigastric pain was reported to be “better” and the applicant was “off both Naprosyn and Somac” at the time of a GP consultation on 6 February 2020. It is noted reference was also made by the GP to alcohol use as a possible cause of that episode,[33] although it seems the applicant also had an earlier history of consuming alcohol[34] without similar effects.[31] Reply, p 60.
[32] Reply, p 75.
[33] Reply, p 78.
[34] Reply, p 61.
Given the clinical history as recorded in the GP notes, it would not be correct to accept the applicant had no gastrointestinal symptoms prior to early 2021, if that was his recollection of the timeline as expressed to Dr Sethi at the medical examination. The evidence establishes the applicant having relevant symptoms within weeks of being prescribed Panadeine Forte. Further symptoms were noted during the ensuing 12 months, and it seems the GP thought there may have been a connection between epigastric pain and prescribed medications (in that instance, Naprosyn). While Dr Sethi’s remarks about the delay between the prescription of medication and onset of symptoms are noted, his opinion as it relates to that issue is contradicted by the clinical records. I prefer the latter as they were contemporaneous.
The respondent criticised the applicant and Dr Greenberg for their failure to include a history or relevant timeline for the onset of gastrointestinal symptoms and it is correct those are absent from the applicant’s statement and that specialist’s medical reports. The GP clinical notes do though provide a reliable account of relevant symptoms during the two-year period in question. As has already been identified, relevant symptoms were present relatively soon after medications noted by both Dr Greenberg and Dr Sethi were prescribed. The absence of a timeline in the applicant’s evidence and reports of Dr Greenberg is not considered to be a critical matter in these circumstances.
Dr Sethi thought the applicant’s gastrointestinal condition to be unconnected with the workplace injury, primarily because the injury did not involve the gastrointestinal tract. In relation to consequential considerations, he remarked the applicant had indications of GORD which he identified as a “common condition” present in 15 to 20% of the population. The applicant smoking cigarettes was also presumed to be a likely significant factor contributing to the presence of GORD. Dr Sethi thought the applicant’s irregular bowel habits were suggestive of irritable bowel syndrome (IBS), for which smoking was also a relevant factor (Dr Greenberg doubts the presence of IBS). He rejected the suggestion that the prescribed medications accounted for the applicant’s gastrointestinal symptoms. That was apparently premised upon the claimed two-year delay with the onset of symptoms. The specialist considered related symptoms would be expected soon after the medications were prescribed.
While Dr Sethi accepted some prescribed medications may have the potential for gastrointestinal symptoms, he considered they were not relevant or applicable to the applicant’s situation but did not provide any detailed explanation in support of that opinion other than his earlier expressed view about the purported delay with the onset of symptoms. I do not accept that view given the contra clinical records evidence; there was little, if any, real delay with symptoms.
Both Dr Greenberg and Dr Sethi agree the applicant is likely to have GORD, the latter refers to it being a “common condition”, which supports his view that it developed of its “own accord”. As highlighted by Dr Greenberg, the applicant is not necessarily in the 15 to 20% cohort of the population identified by Dr Sethi.[35] While it may be that statistical probability exists, the prescribed medications can be a likely cause as has been identified by both specialists. The reason Dr Sethi categorically rejects that possible connection in the case of the applicant is not made clear in any of his reports.
[35] Greenberg-3, p 2.
Cigarette smoking, also taken into account by Dr Greenberg as a factor by way of possible aggravation, is undoubtedly a relevant consideration. The applicant is recorded as having been a smoker of 10 cigarettes per day, having commenced in 1995.[36] He had been a smoker for around 23 years by the time he was prescribed medication to treat the workplace injuries, without any symptoms of GORD, or apparently any other gastrointestinal condition, until then. Such symptoms did arise though several weeks after first being prescribed Panadeine Forte on 31 January 2019. The timing of events would, of itself, suggest some connection. While it may be relevant, smoking can reasonably be discounted as the initiating factor given the sequence of events and lengthy period spent smoking without any recorded gastrointestinal symptoms.
[36] Reply, p 55.
The medical experts both accept that medication induced gastrointestinal symptoms are possible, although Dr Sethi rejects any link with respect to the applicant. Once the issues of smoking and delay are isolated, the most likely conclusion is that there is a connection between the medication prescribed for treatment of the applicant’s workplace injury and the onset of gastrointestinal symptoms. That is the opinion of Dr Greenberg, I accept it as the most likely proposition in the circumstances.
Adopting a commonsense approach, I am satisfied that it is more probable than not the medication prescribed for treatment of the applicant’s workplace injury made a material contribution to, and was most likely the cause of, his gastrointestinal condition for which there is a record of symptoms first presenting during March 2019. Accordingly, I am persuaded that the applicant has met the required onus to establish he has suffered a consequential gastrointestinal condition that results from the workplace injury on 5 November 2018.
A final matter of note is that I consider, contrary to the views expressed in Dr Sethi’s reports, Dr Greenberg to be eminently qualified to provide expert opinion on medical matters of the type in these proceedings. It is sufficient to note that he has extensive experience as a surgeon of more than 30 years as a specialist treating gastrointestinal conditions. While it is noted Dr Sethi engages in specialist practice different to that of Dr Greenberg, the opinions of both experts have been duly considered with reference to their qualifications as independent medical examiners.
I place no greater weight on the qualifications of one specialist over the other. I do though consider the reasoning provided by Dr Greenberg to be more compelling with respect to the central issue to be resolved given the measured and cogent explanation included in his reports that address the nature of the prescribed medications with reference to specific medical literature.
SUMMARY
The applicant developed a gastrointestinal condition from medication prescribed for the treatment of workplace injury sustained on 5 November 2018. It is accepted as a consequential condition.
The applicant’s claim for lump sum compensation now requires referral to a Medical Assessor, for assessment of the level of his whole person impairment in relation to his right shoulder, cervical spine, respiratory system, visual system and gastrointestinal condition.
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