Tsiklas v Catering Industries Pty Ltd

CERTIFICATE OF DETERMINATION OF MEMBER 

CITATION:

Tsiklas v Catering Industries Pty Ltd [2024] NSWPIC 512

APPLICANT:

Vasilia Tsiklas

RESPONDENT:

Catering Industries Pty Ltd

MEMBER:

Carolyn Rimmer

DATE OF DECISION:

16 September 2024

CATCHWORDS:

WORKERS COMPENSATION - Workers Compensation Act 1987; claim for section 60 expenses in respect of left total knee replacement following injury to right knee and lumbar spine; whether consequential condition in the left knee had resolved; Held – treatment is reasonably necessary as a result of the injuries sustained; respondent to pay the costs of medical or related treatment expenses.

DETERMINATIONS MADE:

The Commission determines:

1. Respondent to pay the applicant’s medical and associated treatment expenses pursuant to s 60 of the Workers Compensation Act1987 in respect of the left total knee replacement performed on 13 June 2023, on production of accounts, receipts and/or Medicare Notice of Charge.

STATEMENT OF REASONS

BACKGROUND

1. The applicant Vasilia Tsiklas, (the applicant) was employed by Catering Industries Pty Ltd (the respondent) as a catering assistant. The respondent was insured by Employers Mutual (NSW) Limited (the insurer) at the relevant time.

2. In the course of her employment on 16 June 2019, the applicant slipped and fell, sustaining injury to her lumbar spine and bilateral knee injuries and/or a consequential injury to the left knee as a result of the injury to her right knee.

3. The applicant made a claim for weekly benefits, fees in respect of left knee reconstruction surgery and fees in relation to proposed right knee reconstruction surgery as a result of the injury on 16 June 2019.

4. The respondent disputed liability for the claim for the surgery to the left knee, proposed surgery to the right knee and the claim for weekly benefits.

ISSUES FOR DETERMINATION

1. The parties agree that the following issue remains in dispute:

   (a)    whether the left knee total reconstruction surgery and associated expenses treatment was reasonably necessary.

PROCEDURE BEFORE THE PERSONAL INJURY COMMISSION

1. The parties attended a conciliation conference and arbitration via video link on 5 September 2024. The applicant was represented by Mr Boris Necovski, who was instructed by Mr Deng of Spinak Solicitors. The respondent was represented by Mr Phillip Perry, who was instructed by Ms Isreal of Bartier Perry Lawyers. Ms Patterson from the insurer also attended the conciliation conference and arbitration.

2. 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

1. The following documents were in evidence before the Personal Injury Commission (Commission) and considered in making this determination:

   (a)    Application to Resolve a Dispute and attached documents;

   (b)    Reply and attached documents;

   (c)    Application to Admit Late Documents…