White v Strikeforce AMC Pty Ltd

CERTIFICATE OF DETERMINATION OF MEMBER
CITATION:	White v Strikeforce AMC Pty Ltd [2025] NSWPIC 479
APPLICANT:	Carolyn White
RESPONDENT:	Strikeforce AMC Pty Ltd
MEMBER:	Gaius Whiffin
DATE OF DECISION:	16 September 2025
CATCHWORDS:	WORKERS COMPENSATION - Workers Compensation Act 1987; claim for injuries to left shoulder and consequent chronic regional pain syndrome; claim for proposed future treatment expenses pursuant to section 60 being the provision and the fitting of a tailored dynamic arm splint and a tailored arm sleeve (quoted at $2,077.49); consideration of applicant’s statements, medical reports and other treatment records, and claim correspondence; consideration of whether the proposed treatment is reasonably necessary medical treatment for the applicant as a result of her accepted injury to her left shoulder; Rose v Health Commission (NSW), Diab v NRMA Limited, and Murphy v Allity Management Services Pty Limited applied; Held – the treatment proposed for the applicant is reasonably necessary medical treatment as a result of her injury; respondent ordered to pay the quoted cost for the treatment.
DETERMINATIONS MADE:	The Commission determines: 1. The provision and the fitting of both the tailored dynamic arm splint and the tailored arm sleeve for the applicant (as referred to in the quotation from Second Skin Pty Ltd dated 4 December 2024) are reasonably necessary medical expenses (in accordance with s 60 of the Workers Compensation Act 1987 (the 1987 Act)) as a result of the applicant’s accepted injury on 10 September 2020. The Commission orders: 2. Pursuant to s 60 of the 1987 Act, the respondent is to pay the amount of $2,077.49 (in accordance with the quotation from Second Skin Pty Ltd dated 4 December 2024 – including fitting and freight fees) for the provision and fitting of both a tailored dynamic arm splint and a tailored arm sleeve for the applicant. A brief statement is attached setting out the Commission’s reasons for the determination.

STATEMENT OF REASONS

BACKGROUND

Carolyn White (the applicant) is 55 years old. She was employed by Strikeforce AMC Pty Ltd (the respondent) from 2018, as a brand ambassador.
She injured her left shoulder during her employment with the respondent on 10 September 2020.
The respondent has accepted that the applicant sustained this left shoulder injury, which arose out of or in the course of her employment with it pursuant to s 4 of the Workers Compensation Act 1987 (the 1987 Act). It has also accepted that her employment was a substantial contributing factor to the injury pursuant to s 9A of the 1987 Act. It has in this regard made weekly benefits compensation payments to her, as well as payments to or on her behalf pursuant to s 60 of the 1987 Act.
The applicant alleges that the left shoulder condition has resulted in her developing a chronic regional pain syndrome (CRPS). The CRPS was diagnosed by her treating pain specialist, Dr Shahzad, who has recommended that she be provided with a tailored dynamic arm splint (the tailored arm splint) and a tailored arm sleeve (the arm sleeve) - to be provided pursuant to a quotation from Second Skin Pty Ltd dated 4 December 2024.
The applicant claimed the expenses quoted by Second Skin Pty Ltd from the respondent, in accordance with s 60 of the 1987 Act.
Subsequent to that claim, the respondent issued two notices pursuant to s 78 of the Workplace Injury Management and Workers Compensation Act 1998 (the 1998 Act) both dated 18 December 2024:
(a) the first notice denied liability in relation to the applicant’s claimed consequential CRPS, disputing the CRPS diagnosis, and
(b) the second notice denied liability in relation to the provision of the tailored arm splint – but approved the costs involved in the provision of the arm sleeve.
By way of an Application to Resolve a Dispute (ARD) filed with the Personal Injury Commission (Commission), the applicant requests an order that the respondent pay for the costs of and incidental to the provision and fitting of both the tailored arm splint and the arm sleeve, in accordance with the quotation from Second Skin Pty Ltd dated 4 December 2024.

ISSUE FOR DETERMINATION

The parties agree that only the following issue is in dispute in these proceedings:
(a) whether the provision and the fitting of both the tailored arm splint and the arm sleeve are reasonably necessary medical expenses (in accordance with s 60 of the 1987 Act) arising out of the applicant’s accepted injury on
10 September 2020.

PROCEDURE BEFORE THE PERSONAL INJURY COMMISSION

I am satisfied that the parties to these proceedings 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 a settlement acceptable to both 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.
The proceedings came before me for a preliminary conference (by MS Teams audiovisual link) on 4 July 2025. Ms Petkovic appeared as the legal representative for the applicant, and Ms Costello appeared as the legal representative for the respondent. The applicant also appeared, as did Mr Masuku from the respondent’s insurer. A conciliated resolution of the issue in dispute in the proceedings (see paragraph 8 above) was then unable to be reached.
Considering the extent of the evidence before me as well as the limited nature of the dispute to be determined by me (see paragraph 8 above), the parties were informed of my intention to determine the dispute without holding a further conciliation conference or arbitration hearing. There was no objection from either party to this course.
I therefore ordered a timetable for the provision of written submissions by both parties, and I ordered that:
“At the conclusion of the time allowed for submissions the dispute will be determined ‘on the papers’.”
The respondent provided written submissions dated 18 July 2025. The applicant has however not provided any written submissions, despite my order (dated 4 August 2025) extending the time for her to make written submissions until 8 August 2025. I therefore propose to determine the proceedings without the benefit of any written submissions provided by the applicant.

EVIDENCE

Documentary evidence

The following documents were in evidence before me and considered by me in making this determination:
(a) the ARD and attached documents, and
(b) the respondent’s Reply (Reply) and attached documents.

Oral evidence

No oral evidence was given before me in the proceedings.

Applicant’s evidence

The applicant’s signed statement dated 28 May 2025 is found at page 1 of the ARD.
She began her employment with the respondent in 2018 as a casual brand ambassador, and she says that prior to that date, she did not suffer from any pain or restrictions in her left shoulder, and she was “able to wholly engage with activities of daily living without compromise”.
She describes her injury on 10 September 2020:
“On 10 September 2020, whilst in the course of my duties, I was doing a point of sale. I was pulling up a large floor decal which was quite stuck. As I was pulling the decal up, I felt an onset of pain in my left shoulder but continued to finish my shift at the store. Following this, I went home but the next morning, I was in excruciating pain, so I utilised the weekend to rest and recover, using heat and ice alongside pain killers.”
She says that she consulted with her general practitioner (Dr Chalissery) on
15 September 2020, when she was prescribed medication and referred for radiological tests.
She was subsequently referred for further radiological tests, physiotherapy, and a cortisone injection into her left shoulder. Then, she was referred to an orthopaedic surgeon
(Dr Jansen), whom she initially consulted on 23 November 2020. She underwent a further cortisone injection, but as that injection provided no prolonged benefit, she underwent surgery in the form of a left shoulder arthroscopy under Dr Jansen on 25 February 2021.
She then continued to regularly consult with Drs Chalissery and Jansen, complaining of persistent pain and restricted range of movement in her left shoulder. She had a further cortisone injection on 30 March 2022, and underwent a further left shoulder arthroscopy under Dr Jansen on 4 August 2022.
She says that by her 23 January 2023 consultation with Dr Jansen, she was “feeling much better” but still experiencing mild residual pain and stiffness. However, by the time of her
29 May 2023 consultation with Dr Chalissery, “the pain in my neck and back had become intense and caused tightness”. She then relates the following consultations with
Dr Chalissery:
(a)    7 June 2023 – “complained of pins and needles in my feet, calves and hands. I complained that the pain radiated to my shoulders and arms. I informed
Dr Chalissery that my lower back was quite sore, and that it ached”;
(b)    13 June 2023 – “complained of pins and needles, alongside swelling on my left shoulder”, and
(c)    14 October 2024 – “complained of pins and needles, alongside tingling in my left arm radiating to my left thumb”.
She says that she currently consults with Dr Chalissery monthly, her physiotherapist fortnightly, a psychologist fortnightly, as well as a dietician and a pain specialist.
She then specifically addresses the respondent’s notices pursuant to s 78 of the 1998 Act dated 18 December 2024, and in effect makes submissions “completely” disagreeing with its denial of liability in relation to her suffering a consequential CRPS resulting from her left shoulder injury, and in relation to her reasonably requiring the tailored arm splint. She alleges that Dr Cadden (who had examined her on behalf of the respondent) “did not complete a thorough examination of the subject area” and “did not possess a comprehensive understanding of my left shoulder injury”. She submits that the opinions of Drs Chalissery, Gehr, and Shahzad should be preferred to his opinion.
She concludes:
“I feel that I should have the tailored partial dynamic arm splint and a tailored arm sleeve because I feel like I have exhausted all other treatment options. I am in intense pain and am prepared to try anything to reduce the symptoms and restore some degree of quality of life and hopefully enable me to return to work in some capacity.”
The applicant relies upon a qualified medical report from Dr Gehr dated 5 March 2025, which is found at page 37 of the ARD.
The doctor reviews and summarises extensive medical evidence provided to him from
Drs Chalissery, Jansen, Shahzad, and Cadden, as well as radiological reports. He takes an uncontroversial history of the applicant’s 10 September 2020 injury and her subsequent treatment. In relation to her current symptoms, he records:
“She reports pain in the anterior aspect of the left shoulder, constant, goes down the arm to the left elbow and when it is bad, it goes down to the wrist and hand…On a scale of 0 (no pain) to 10 (very severe), it averages 7. There is associated stiffness of the shoulder making it difficult for dressing such as doing up her bra…It is now over four years since subject accident. Condition is getting worse…She reports pins and needles in the median and ulnar nerve distribution of the left hand when it occurs…She says that clothes cause particular irritation over the left arm, also with bedding. Even temperature changes irritate the left arm and even the wind irritates the left arm.”
The doctor conducts a physical examination where he finds left posterior shoulder muscle wasting, scarring, reduced range of left shoulder movement, left shoulder pain with rotation, and some wasting of the left forearm. In relation to CRPS symptoms, he also finds “continuing pain, disproportionate to event”, sensory changes, dysaesthesia, sweating, left shoulder stiffness, self-reported sensory left hand changes, brittle nails, colour changes to left nails, decreased range of left shoulder movement, as well as no other explanation for the applicant’s symptoms other than CRPS.
The doctor diagnoses:
(a) “1. Left shoulder soft tissue injury, probable labral tear, despite two arthroscopic procedures including AC joint resection, persisting pain and loss of range of motion and posterior shoulder muscle wasting.”, and
(b) “2. CRPS type I secondary to 1. I accept the diagnosis of the pain specialist and I realise that some of the features outlined in page 81 of WorkCover Guidelines would be ameliorated with her current active treatment but many other features, supporting the diagnosis are present as outlined in the body of this text. CRPS is a consequential injury.”
In relation to causation, the doctor opines that the applicant’s employment “was the main contributing factor to the injuries sustained on 10/9/2020”, and that:
“I disagree with the opinion of the insurer. There is no other reason that the CRPS would have risen if it had not been for the injury. CRPS just about always arises after an injury and not spontaneously. So, the consequential condition of CRPS is direct result of the left shoulder injury of 10/9/2020. I would support the opinion of her treating pain specialist that she has CRPS type I as he saw her on several occasions and is well aware of the necessary diagnostic criteria to make that diagnosis…In regard to the report of Dr Cadden, the client today tells me that when she attended for the report, she was having a better day that day and not all the symptoms which had been florid were present on that particular day…I do understand that as per WorkCover Guidelines page 81, that some of the features or criteria for CRPS are not so florid as you would expect when is under treatment, but upon careful observations, many if not, most of the features are present. Therefore, I think it is reasonable to state that she still has CRPS type I…As with any orthopaedic condition, when they get to a medico-legal report, the acute features have passed and now become chronic, and many of the florid features will have been ameliorated.”
The doctor supports the applicant’s use of the tailored arm splint, advising:
“CRPS is a difficult condition to treat with an unpredictable outcome and any treatment that is reasonable is to be used and to use a tailored partial dynamic sleeve is reasonable and necessary.”
The applicant also relies upon a medical report from Dr Shahzad (rehabilitation medicine physician) dated 26 April 2025, which is found at page 66 of the ARD.

The doctor first consulted with the applicant on 31 May 2024, and obtained the following history of her symptoms:
“She has persistent pain symptoms since injury. On visit, she described her pain symptoms as ‘burning fire inside the shoulder’ associated warmth feeling and throbbing constant ache. She reported intensity averaging 5 out of 10 on verbal pain rating scale. In addition, she has started to experience some other symptoms of pins and needles and electricity-like pain associated with significant light and brushing allodynia symptoms. She does describe increased sensitivity with hot and cold water as well as cold weather in the recent months. The individual shared functional limitations due to these persistent pain symptoms and difficulties in managing household tasks such as cleaning and carrying items.”
The doctor’s clinical impression on 31 May 2024 was that the applicant had developed type I CRPS, as her symptoms fulfilled the relevant Budapest Criteria, in that she had continuing pain disproportionate to any inciting event, hyperaesthesia and/or allodynia, decreased range of motion and/or motor dysfunction, as well as no other diagnosis that better explained the applicant’s signs and symptoms. He includes in his report “a full version of Budapest clinical diagnostic criteria for CRPS”, and he opines that the applicant’s CRPS “is a direct consequence of a left shoulder injury and co-exists with a previously treated musculoskeletal injury condition”.
The doctor specifically indicates that the presence of temperature or colour changes is not always necessary for a diagnosis of CRPS to be made.
The doctor reviews the applicant’s treatment history at the 31 May 2024 consultation, as well as at a consultation in September 2024. In his report, he outlines that on 31 May 2024, he recommended various pharmacotherapy treatment, the trial of a transcutaneous electrical nerve stimulation (TENS) machine, enrolment in a chronic pain program, enrolment with a pain management group, and education. In September 2024, he made similar recommendations, but he also recommended braces, including:
“For compression to shoulder region, Tailored Arm Splints made by Second Skin or OMOTRAIN SHOULDER SUPPORT from Beurfeind company. To add, Dynamic Arm Splints and Arm Sleeves are used for compression purpose. I have noted that these were quoted by Second Skin Pty Ltd. (dated 4/12/2024). Both Dynamic Arm Splints and Arm Sleeves are reasonable treatments for symptoms treatment (swelling) and also provide heat application and considered beneficial in the management of Complex Regional Pain Syndrome (CRPS). Also, Dynamic Arm Splints and Arm Sleeves are use on different times of the day…There are multiple benefits of Compression therapy can help improve circulation and potentially reduce neuropathic pain in CRPS. A dynamic arm splint by Second Skin Pty Ltd. are custom-made to fit the individual's specific upper limb dimension, and zip design allow ease of application by family/carers or client where possible.”
The doctor’s report finally provides a website link to a page explaining Second Skin Pty Ltd’s dynamic arm splints.
The applicant further relies upon a medical report from Dr Chalissery dated 20 February 2025, which is found at page 57 of the ARD.
The doctor includes in his report a summary of his clinical notes on 55 occasions when he has treated the applicant since she first consulted him regarding her 10 September 2020 left shoulder injury. He notes that the applicant’s symptoms have “waxed and waned”, and that any improvements in the symptoms have been temporary as “her pain kept escalating and was the shoulder, neck and the upper back and chest with other symptoms like swelling, poor sleep etc”. He also notes her two shoulder operations under Dr Jansen; as well as Dr Shahzad’s diagnosis of CRPS and institution of pain management, which has led to the applicant undertaking pain management courses and using antidepressants, nerve blockers, and strong analgesia.
He says that he initially suspected the diagnosis of CRPS during his consultation with the applicant on 15 March 2024, and referred her to Dr Shahzad for confirmation. He confirms:
“Yes, I disagree with the insurers opinion that CRPS is not a consequence of her injury sustained in 2020. Carolyn did not have CRPS prior to the injury. The CRPS is a direct consequence of the injury. I initially suspected it due to the chronicity and unrelenting nature of her pain along with other symptoms.”
He then defers his opinions to Dr Shahzad:
“Dr Shahzad is a pain and rehab specialist. He is well versed with pain criteria. He examined Carolyn and confirmed my working diagnosis of CRPS based on the Budapest Criteria in his interview and examination of Carolyn on 31/05/24…I suspected CRPS based on the change in the Carolyn’s pain early in March 2024 and Dr Shahzad confirmed it in his letter in June 2024. I am not an expert in pain criteria – Dr Shahzad is and therefore he will be the right person to confirm the diagnosis based on his expertise…I am not a pain specialist and I cannot comment on the usefulness and evidence for a tailored partial dynamic arm sleeve, Dr Shahzad is a pain specialist and this question should be directed to him.”
The ARD also contains the following further evidence:
(a)    reports from Dr Jansen dated 25 February 2021 and 4 August 2022 – explaining the nature of the left shoulder arthroscopies he performed upon the applicant on those dates;
(b) various radiological reports - which I have considered but will only detail further (in accordance with cl 67D(2) of the Personal Injury Commission Rules 2021 (the Rules)) if specifically directed to them in the parties’ submissions;
(c)    clinical notes from Tongarra Family Practice (Dr Chalissery’s practice) - which I have considered and which are relevantly summarised in Dr Chalissery’s
20 February 2025 report (see paragraph 39 above) - again I will not detail the notes further (in accordance with cl 67D(2) of the Rules) unless specifically directed to aspects of them in the parties’ submissions, and
(d)    a quotation from Second Skin Pty Ltd dated 4 December 2024 (referred to in
Dr Shahzad’s 26 April 2025 report - and found at page 198 of the ARD) - quoting:
(i)$1,364 for a tailored partial dynamic arm splint;
(ii)$492 for a tailored arm sleeve;
(iii)$193.99 for a fitting consultation, and
(iv)$27.50 for freight fees.

Respondent’s evidence

The respondent largely relies upon opinions from Dr Cadden. The doctor’s first report in this regard dated 29 August 2023 is found at page 62 of the Reply. It follows his examination of the applicant on 20 July 2023.
The doctor takes an uncontroversial history of the applicant’s 10 September 2020 injury and her left shoulder treatment following it. He records examining only her left shoulder, and he only reviews left shoulder radiology. He records the applicant’s ‘current status’:
“She still has not returned to working due to the left shoulder. She describes a constant burning pain, and pain with any pressure to the left shoulder region. She experiences limitations with lifting and carrying and has a restriction with shoulder abduction and extension. She has not been able to return to previous sporting activities and is having difficulties with dressing and household activities.”
The doctor diagnoses the applicant with left shoulder subacromial bursitis and a Type II SLAP lesion. He opines that her restricted range of left shoulder movement arises from the SLAP lesion which occurred following the 10 September 2020 injury. He further opines that the applicant “is still experiencing the effects of the injury to the left shoulder” and “it is likely that she will have a persisting pain with limitations on lifting to the left shoulder”.
In relation to treatment recommendations, the doctor suggests exercise physiology.
The doctor’s next report is dated 16 September 2024, and found at page 70 of the Reply. It follows his further examination of the applicant on 2 September 2024.
The doctor notes that since his first examination, the applicant continues to have “ongoing pain and restriction to the motion of the left shoulder”. The pain increased with elevated activities. The applicant was sleeping on a lounge to prevent rolling onto her left shoulder at night, and she continued to have difficulties with dressing. She found comfort with compression to the shoulder, and she had been referred to a pain specialist, who had recommended the use of medication and a TENS machine. The doctor notes:
“She was given a diagnosis of a chronic regional pain syndrome but does not experience colour changes to the left arm. She will experience some swelling to the shoulder with occasional change to the temperature and occasional spasm. She does describe a throbbing and burning sensation to the arm which is constant in nature. This is often worse at night. She has not experienced any hair loss to the arm, but does experience dry skin to both arms.”
On examination, the doctor finds restricted range of left shoulder movement, normal range of left wrist and elbow movement, and “a mild hypersensitivity when light touch to the left arm was removed”. He did not find “cold changes to the left with dependency or activity”.
The doctor confirms his diagnosis from his 29 August 2023 report, and assesses the applicant’s permanent impairment at 7% without having regard to any CRPS.
The doctor’s next report is dated 21 October 2024 and found at page 79 of the Reply. The report answers questions posed to the doctor by the respondent’s insurer regarding the applicant’s capacity for work.
The doctor’s next report is dated 4 November 2024 and found at page 81 of the Reply. The report answers questions posed to the doctor by the respondent’s insurer regarding whether he would diagnose the applicant with CRPS. The doctor opines:
“She demonstrated and gave a history of chronic pain involving the left arm that on the day of examination on 2 September 2024 she did not meet the criteria to be diagnosed with a chronic regional pain syndrome type I. She did not demonstrate the colour changes, or temperature changes to the left.”
The doctor’s next report is dated 13 November 2024 and found at page 160 of the Reply. The report answers questions posed to the doctor by the respondent’s insurer regarding the applicant’s treatment needs. Relevantly, the doctor advises:
“She has developed a chronic pain to the left arm as result of the work place injury. Treatment to assist with the chronic pain would be considered reasonably necessary. The second skin seems to be for a fitting of sleeve to decrease light touch sensitivity and is reasonably necessary.”
The doctor’s final report is dated 21 January 2025 and found at page 162 of the Reply. The report answers more specific questions posed to the doctor by the respondent’s insurer regarding the applicant’s treatment needs.
The doctor again explains that the applicant “does not have the features of a chronic regional pain syndrome”, and therefore does not require physiotherapy treatment. In relation to the fitting of the tailored arm splint referred to in the quotation from Second Skin Pty Ltd dated
4 December 2024, the doctor advises:
“Dr Shahzad would be of more knowledge as to the appropriate Garment that would be required for her left arm. I would be more of the opinion to follow the advice of
Dr Shahzad and make use of the compression garment to begin with given the cost for the tailored partial dynamic arm splint.”
I have considered the remainder of the medical evidence attached to the Reply. It largely consists of:
(a)    reports from Dr Jansen in relation to his treatment of the applicant’s left shoulder up to 7 June 2023;
(b)    some radiological reports in relation to the left shoulder;
(c)    clinical notes from Tongarra Family Practice (Dr Chalissery’s practice);
(d)    a report dated 12 November 2024 (addressed to Dr Shahzad) in relation to the applicant’s attendance at a pain management program - the report recommends ongoing physiotherapy and psychological treatment for the applicant’s chronic pain, and
(e)    a report from a physiotherapist dated 4 April 2025 - referring to the applicant describing her ongoing pain as a “burning, throbbing gravel rash” - the physiotherapist was attempting to assist the applicant to better manage her pain levels, and to desensitise her left arm.
I will only detail this evidence further (in accordance with cl 67D(2) of the Rules) if specifically directed to it in the parties’ submissions.

Respondent’s submissions

The respondent has provided written submissions dated 18 July 2025. The submissions form part of the Commission’s record and I will not therefore outline them in detail.
The submissions commence by summarising the respondent’s two notices pursuant to s 78 of the 1998 Act - see paragraph 6 above.
In relation to the first notice, which denied liability for the applicant’s alleged CRPS:
(a)    the respondent emphasises Dr Cadden’s opinion in his 16 September 2024 report (see paragraphs 48-49 above) that as the applicant did not experience colour changes to her left arm, his clinical examination of her was not consistent with a diagnosis of CRPS;
(b)    the respondent emphasises Dr Cadden’s opinion in his 4 November 2024 report (see paragraph 52 above) that the applicant’s presentation was consistent with a chronic pain diagnosis rather than a diagnosis of CRPS, due to the lack of colour and temperature changes to her left arm;
(c)    the respondent emphasises that CRPS was not considered or reported in the pain management program report dated 12 November 2024 – see paragraph 56(d) above;
(d)    the respondent submits that Dr Chalissery does not provide an objective opinion to support a diagnosis of CRPS, but rather relies upon Dr Shahzad’s opinion in this regard, and
(e)    the respondent submits that it has “therefore determined there is insufficient evidence to support the applicant’s injury/reported symptoms fulfilled the diagnostic criteria for CRPS 1 as a result of her work injury”.
In relation to the second notice, which denied liability in relation to the provision of the tailored arm splint:
(a)    the respondent submits that the “notice confirmed the recommendation from
Dr Shahzad involved only a compression garment to improve swelling and provide support for the applicant’s shoulder region, and it did not support or suggest a dynamic splint with additional features as quoted by Second Skin Pty Ltd, was indicated or appropriate”;
(b)    the respondent confirms that it has approved the costs associated with the provision of the arm sleeve referred to in the quotation from Second Skin Pty Ltd dated 4 December 2024, and
(c)    the respondent notes alternative treatment recommended by Dr Shahzad (see paragraph 36 above), being an OmoTrain shoulder support – which it alleges (without providing supporting evidence) costs $239.95.
The respondent then refers me to Rose v Health Commission (NSW) (1986) 2 NSWCCR 2 (Rose) and Diab v NRMA Limited [2014] NSWWCCPD 72 (Diab), and summarises:
“In circumstances where EML support the provision of a compression garment for treatment of the applicant’s left shoulder chronic pain for the purposes of improving swelling and providing support; where Dr Shahzad has referenced a more cost-effective option in his reports than the tailored arm splint; and where there is no evidence tendered by the applicant as to why the tailored arm splint is the more appropriate treatment by comparison to the OmoTrain shoulder support, the respondent submits the Commission cannot be satisfied the applicant has established the tailored arm splint is reasonably necessary in the circumstances.”
The respondent then relies upon ICI Australia Operations Pty Limited (now known as Orica Australia Pty Limited) & 1 Ors v The WorkCover Authority of New South Wales[2004] NSWCA 55, in order to submit as follows:
“Further, the respondent submits it is not open to the Commission to fill in gaps in the medical evidence which fails to address why the tailored arm splint is ‘more appropriate’ to treat the applicant’s condition when compared to the OmoTrain shoulder support from the Beurfeind company, which was also recommended by Dr Shahzad.”
Finally, the respondent refers to the decision of Member Garner in Kemp v Cater Care Australia Operations Pty Ltd [2023] NSWPIC 256 (Kemp), where she relied upon Elsworthy v Forgacs Engineering Pty Ltd [2017] NSWWCC 64 (Elsworthy) and Jaffarie v Quality Castings Pty Ltd [2014] NSWWCCPD (Jaffarie). She then determined (at [94]):
“The issue of whether the applicant has a rateable chronic regional post-electric pain disorder in the left upper limb, left shoulder, left sided neck, face and upper back is a matter for assessment by a Medical Assessor.”
The respondent submits that it is not open for me, as a Member, to determine whether the applicant suffers from CRPS, as that is a question to be determined by a Medical Assessor. However, it is important to note in this regard that the claims in Kemp, Elsworthy, and Jaffarie were all claims by workers pursuant to s 66 of the 1987 Act for lump sum compensation in relation to permanent impairment. Such claims require the permanent impairment to be assessed as prescribed by the SIRA NSW Workers Compensation Guidelines for the Evaluation of Permanent Impairment, 4^th ed, 1 March 2021 (the Guidelines). Chapter 17 of the Guidelines requires a Medical Assessor (when assessing permanent impairment) to independently diagnose CRPS before assessing any permanent impairment caused by it.

Applicant’s submissions

As indicated (see paragraph 13 above), the applicant has not provided any submissions.

FINDINGS AND REASONS

Is the provision and the fitting of both the tailored arm splint and the arm sleeve reasonably necessary medical expenses (in accordance with s 60 of the 1987 Act) arising out of the applicant’s accepted injury on 10 September 2020

Section 60 (1) of the 1987 Act provides as follows:
“(1) If, as a result of an injury received by a worker, it is reasonably necessary that--
(a) any medical or related treatment (other than domestic assistance) be given, or
(b) any hospital treatment be given, or
(c) any ambulance service be provided, or
(d) any workplace rehabilitation service be provided,
the worker's employer is liable to pay, in addition to any other compensation under this Act, the cost of that treatment or service and the related travel expenses specified in subsection (2).”
Section 59 of the 1987 Act then defines ‘medical or related treatment’ as including:
“(a)    treatment by a medical practitioner, a registered dentist, a dental prosthetist, a registered physiotherapist, a chiropractor, an osteopath, a masseur, a remedial medical gymnast or a speech therapist,
(b)     therapeutic treatment given by direction of a medical practitioner,
(d)     the provision of crutches, artificial members, eyes or teeth and other artificial aids or spectacles,
(e)     any nursing, medicines, medical or surgical supplies or curative apparatus, supplied or provided for the worker otherwise than as hospital treatment,
(f)      care (other than nursing care) of a worker in the worker's home directed by a medical practitioner having regard to the nature of the worker's incapacity,
(f1)    domestic assistance services,
(g)     the modification of a worker's home or vehicle directed by a medical practitioner having regard to the nature of the worker's incapacity, and
(h)     treatment or other thing prescribed by the regulations as medical or related treatment.”
There has been no dispute raised that the applicant’s claim to be provided with the tailored arm splint and the arm sleeve relates to treatment covered by s 59 of the 1987 Act. It is therapeutic treatment, and both items are curative apparatus.
The respondent has also accepted that the provision of the arm sleeve is reasonably necessary treatment, and has approved the provision of it.
The outstanding question to therefore determine is whether the tailored arm splint is reasonably necessary medical treatment, arising out of the applicant’s 10 September 2020 injury.
The standard test adopted in determining if medical treatment is reasonably necessary as a result of a work injury is that stated by Burke CCJ in Rose, where his Honour said:
“3.     Any necessity for relevant treatment results from the injury where its purpose and potential effect is to alleviate the consequences of injury.
4.      It is reasonably necessary that such treatment be afforded a worker if this Court concludes, exercising prudence, sound judgment and good sense, that it is so. That involves the Court in deciding, on the facts as it finds them, that the particular treatment is essential to, should be afforded to, and should not be forborne by, the worker.
5.      In so deciding, the Court will have regard to medical opinion as to the relevance and appropriateness of the particular treatment, any available alternative treatment, the cost factor, the actual or potential effectiveness of the treatment and its place in the usual medical armoury of treatments for the particular condition.”
In Diab, Roche DP considered Rose and concluded (at [86-89]):
“Reasonably necessary does not mean ‘absolutely necessary’ (Moorebank at [154]). If something is ‘necessary’, in the sense of indispensable, it will be ‘reasonably necessary’. That is because reasonably necessary is a lesser requirement than ‘necessary’. Depending on the circumstances, a range of different treatments may qualify as ‘reasonably necessary’ and a worker only has to establish that the treatment claimed is one of those treatments. A worker certainly does not have to establish that the treatment is ‘reasonable and necessary’, which is a significantly more demanding test that many insurers and doctors apply. Dr Bodel and Dr Meakin were both wrong to apply that test.
Giles JA added (at [49] in O’Shea) that the qualification whereby the necessity must be reasonable calls for an assessment of the necessity having regard to all relevant matters, according to the criteria of reasonableness. His Honour was talking in the context of whether an easement should be granted under s 88K of the Conveyancing Act1919, which provides that ‘the Court may make an order imposing an easement over land if the easement is reasonably necessary for the effective use or development of other land that will have the benefit of the easement’. However, his Honour’s observations are applicable in the present matter and are clearly consistent with Clampett.
In the context of s 60, the relevant matters, according to the criteria of reasonableness, include, but are not necessarily limited to, the matters noted by Burke CCJ at point (5) in Rose (see [76] above), namely:
·(a) the appropriateness of the particular treatment;
·(b) the availability of alternative treatment, and its potential effectiveness;
·(c) the cost of the treatment;
·(d) the actual or potential effectiveness of the treatment, and
·(e) the acceptance by medical experts of the treatment as being appropriate and likely to be effective.
With respect to point (d), it should be noted that while the effectiveness of the treatment is relevant to whether the treatment was reasonably necessary, it is certainly not determinative. The evidence may show that the same outcome could be achieved by a different treatment, but at a much lower cost. Similarly, bearing in mind that all treatment, especially surgery, carries a risk of a less than ideal result, a poor outcome does not necessarily mean that the treatment was not reasonably necessary. As always, each case will depend on its facts.”
In Murphy v Allity Management Services Pty Limited [2015] NSWWCCPD 49 (Murphy), Roche DP stated (at [58]):
“Ms Murphy only has to establish, applying the commonsense test of causation (Kooragang Cement Pty Ltd v Bates(1994) 35 NSWLR 452; 10 NSWCCR 796), that the treatment is reasonably necessary ‘as a result of’ the injury (see Taxis Combined Services (Victoria) Pty Ltd v Schokman[2014] NSWWCCPD 18 at [40]–[55]). That is, she has to establish that the injury materially contributed to the need for the surgery (see the discussion on the test of causation in Sutherland Shire Council v Baltica General Insurance Co Ltd(1996) 12 NSWCCR 716).”
I am satisfied that the applicant has been correctly diagnosed with CRPS by Dr Shahzad. The diagnosis was initially suspected by Dr Chalissery, who referred her to Dr Shahzad for confirmation. I consider these treating doctors to be in the best possible position to make the diagnosis, considering that (in comparison with Drs Gehr and Cadden) they have consulted with the applicant on more than one occasion. Indeed, Dr Chalissery had in fact consulted with the applicant on 55 occasions (see paragraph 39 above) between 10 September 2020 and 20 February 2025, and is satisfied (see paragraph 40 above) as to both a diagnosis of CRPS in relation to the applicant, and a direct causative link between the CRPS and the applicant’s 10 September 2020 injury.
The diagnosis was also confirmed by Dr Gehr, who found it to be consistent with his physical examination of the applicant (see paragraphs 28-29 above). He opines that (see paragraph 30 above) “upon careful observations, many if not, most of the features [of CRPS] are present”, and that the CRPS results from the 10 September 2020 injury.
Dr Cadden provides the only medical opinion in evidence disputing the diagnosis of CRPS. He seems to discount the diagnosis (see paragraph 53 above) on the basis that the applicant did not demonstrate left arm colour changes or temperature changes when he examined her on 2 September 2024. However, he did diagnose the applicant with chronic pain resulting from the 10 September 2020 injury.
Dr Gehr however does (see paragraph 28 above) find colour changes to the applicant’s left nails, as well as sensory changes, dysaesthesia, and sweating. Dr Shahzad also finds sensory changes and explains (see paragraph 35 above) that temperature changes or colour changes are not always necessary for a diagnosis of CRPS to be made.
As Dr Shahzad is a rehabilitation medicine physician, and the applicant’s treating pain specialist, Dr Chalissery defers to his opinion (see paragraph 41 above). Dr Cadden (who is an orthopaedic surgeon rather than a pain specialist) also to a degree defers to his opinion (see paragraph 55 above), at least in relation to the applicant’s treatment regime.

Importantly in this regard, Dr Cadden’s diagnostic focus is on the applicant not experiencing left arm colour changes or temperature changes, without fully explaining or exploring the Budapest Criteria necessary for a diagnosis of CRPS to be made. Dr Shahzad on the other hand (see paragraph 34 above) includes in his report specific details of the acknowledged Budapest Criteria, in order to justify his diagnosis of the applicant’s CRPS.
Having regard to Dr Shahzad’s expertise as a pain specialist, together with the support given to his diagnosis of CRPS by Drs Gehr and Chalissery, I find his diagnosis to be more reliable than Dr Cadden’s.
I reject the respondent’s submission (at paragraphs 63-64 above) that I (as a Member rather than a Medical Assessor) am unable to determine whether the applicant has been correctly diagnosed with CRPS. In this regard, the authorities relied upon by the respondent in its submissions deal with claims by workers pursuant to s 66 of the 1987 Act (which require assessment by a Medical Assessor in accordance with the Guidelines). It is only by reason of the Guidelines that a Medical Assessor is required to independently determine CRPS in such claims. The Guidelines however do not require such an independent medical assessment in a claim for reasonably necessary medical expenses in accordance with s 60 of the 1987 Act.
Having preferred the evidence of Dr Shahzad to Dr Cadden regarding the applicant’s CRPS diagnosis, I also accept the unanimous evidence of Drs Shahzad, Gehr and Chalissery that the CPRS results from the 10 September 2020 injury, in order (in accordance with Murphy) to render treatment for it to be compensable pursuant to s 60 of the 1987 Act as resulting from that injury.
I also prefer the evidence of Dr Shahzad regarding treatment options for the CRPS. Indeed, as noted at paragraph 78 above, Dr Cadden even seems to defer to Dr Shahzad in this regard.
Dr Shahzad, as the applicant’s treating pain specialist, develops a co-ordinated treatment regime for the applicant during his first consultation with her on 31 May 2024, and then expands upon that treatment regime at his next consultation with her in September 2024 – see paragraph 36 above. He recommends the tailored arm splint for compression purposes, to provide heat, to improve circulation, to reduce pain, and to reduce swelling. He says that the tailored arm splint is reasonable treatment for the applicant, and the provision of such a splint is considered beneficial in the management of CRPS.
While the doctor refers to the possibility of the applicant being provided with an OmoTrain shoulder support instead of a tailored arm splint, it is in my opinion clear from his report that he would recommend the tailored arm splint to be supplied by Second Skin Pty Ltd. In this regard, he specifically provides a website link to that company in his report, and he also specifically emphasises in the report the fact that tailored arm splints provided by the company are “custom-made to fit the individual’s specific upper limb dimension” and have a design allowing ease of application.
Dr Gehr also directly supports the provision of a tailored arm splint for the applicant as being both reasonable and necessary treatment for her CPRS (see paragraph 31 above).
Dr Chalissery (see paragraph 41 above) advises that he cannot comment on the usefulness of a tailored arm splint, as Dr Shahzad (being the applicant’s pain specialist) should be contacted in this regard. It can be inferred therefore that as Dr Shahzad recommends the tailored arm splint, so would Dr Chalissery.
The respondent submits (see paragraphs 60-62 above) that Dr Shahzad only supports the provision of a compression garment for the applicant, and that the applicant has not provided evidence that the tailored arm splint is more appropriate treatment for her than an OmoTrain shoulder support. I reject these submissions on the following bases:
(a)    while the respondent alleges that an OmoTrain shoulder support only costs $239.95 (compared with $1,364 as quoted by Second Skin Pty Ltd in relation to the tailored arm splint), it has provided no quotation in this regard, or indeed any other evidence regarding the nature of an OmoTrain shoulder support;
(b)    it can be inferred from Dr Shahzad’s 26 April 2025 report that his recommendation for the applicant is a tailored arm splint rather than an Omotrain shoulder support - see paragraph 85 above;
(c)    Dr Shahzad supports the provision of a garment that does more than just provide compression - see paragraph 84 above;
(d)    while Dr Cadden (see paragraph 55 above) recommends a “compression garment to begin with given the cost for the tailored partial dynamic arm splint”, he does so on the understanding that that was Dr Shahzad’s advice - Dr Cadden has not subsequently commented upon Dr Shahzad’s 26 April 2025 report, which as stated in my opinion, clearly favours the provision of the tailored arm splint, and
(e)    Dr Cadden otherwise defers to Dr Shahzad as having more knowledge as to the appropriate garment required for the applicant’s left arm.
In considering the matters referred to in Rose and Diab, I find:
(a)    the provision of the tailored arm splint for the applicant is appropriate treatment – recommended with reasoning in Dr Shahzad’s 26 April 2025 report - supported by Dr Gehr;
(b)    the only alternative treatment to the tailored arm splint that is referred to in the evidence before me is an Omotrain shoulder support - in relation to which I have no evidence as to its potential effectiveness other than that it provides compression – however, Dr Shahzad recommends a garment that provides more than just compression;
(c)    the total cost in the provision for the applicant of the tailored arm splint ($1,364) cannot in my opinion be viewed as excessive;
(d)    the potential effectiveness of the tailored arm splint in the treatment of the applicant’s CRPS is squarely addressed and detailed as being “considered beneficial in the management of” CRPS, in Dr Shahzad’s 26 April 2025 report (see paragraph 36 above) - the doctor there outlines how the tailored arm splint would be effective, and
(e)    considering the opinions of Drs Shahzad, Gehr, and Chalissery, I find that the tailored arm splint has acceptance by medical experts as being appropriate and as likely to be effective in treating the applicant’s CRPS.
In all the circumstances therefore, it seems to me that the tailored arm splint as well as the arm sleeve (together with the necessary fitting and freight costs) are reasonably necessary treatment expenses in relation to the applicant’s CRPS, and I so find. The expenses in this regard total $2,077.49 in accordance with the 4 December 2024 quotation from Second Skin Pty Ltd (see paragraph 42(d) above).

SUMMARY

I formally find that the provision and the fitting of both the tailored dynamic arm splint and the tailored arm sleeve for the applicant (as referred to in the quotation from Second Skin Pty Ltd dated 4 December 2024) are reasonably necessary medical expenses (in accordance with s 60 of the 1987 Act) as a result of the applicant’s accepted injury on 10 September 2020.
There will be accordingly an award in favour of the applicant that the respondent pay the amount of $2,077.49 (in accordance with the relevant quotation and including fitting and freight fees).

[2025] NSWPIC 479

16 September 2025