Williams v Medi-Rent Pty Ltd

CERTIFICATE OF DETERMINATION OF MEMBER
CITATION:	Williams v Medi-Rent Pty Ltd [2025] NSWPIC 563
APPLICANT:	Shaun Williams
RESPONDENT:	MEDI-RENT PTY LIMITED
MEMBER:	Fiona Seaton
DATE OF DECISION:	21 October 2025
CATCHWORDS:	WORKERS COMPENSATION -Workers Compensation Act 1987; claim for cost of dental treatment plan for acid erosion of teeth; the application of crowns on affected teeth disputed; alternative proposal of resin restorations; Held – the dental treatment proposed by the doctors including the application of crowns to the applicant’s affected teeth is reasonably necessary medical or related treatment as the result of the accepted injury pursuant to section 60.
DETERMINATIONS MADE:	The Personal Injury Commission determines: 1. the dental treatment proposed by Dr Hooi and Dr Jimenez is reasonably necessary as a result of injury on deemed date of injury 12 October 2021 pursuant to s 60 of the Workers Compensation Act 1987 (1987 Act), and 2. the applicant is entitled to payment of the costs of the proposed dental treatment plan proposed by Dr Hooi and Dr Jimenez including the application of crowns to his affected teeth pursuant to s 60 of the 1987 Act. The Personal Injury Commission orders: 3. The respondent to pay the costs of the dental treatment plan proposed by Dr Hooi and Dr Jimenez including the application of crowns to the applicant’s affected teeth. A brief statement is attached setting out the Commission’s reasons for the determination.

STATEMENT OF REASONS

BACKGROUND

When the applicant Mr Shaun Williams was employed by the respondent he sustained a psychological injury on or about 12 October 2021. As a result of that accepted injury he developed an eating disorder which led to damage to his teeth.
The applicant’s treating prosthodontist Dr Ken Hooi developed a dental treatment plan in 2023 to address tooth surface loss and associated decline in dentofacial aesthetics and destabilisation of the applicant’s occlusion. The proposal is for orthodontic treatment with Dr Vanessa Jimenez to extract supernumerary teeth, the reversal of occlusal destabilisation with fixed appliances (orthodontic braces), followed by porcelain crowns or veneers on the affected teeth.
The respondent issued a dispute notice under s 78 of the Workplace Injury Management and Workers Compensation Act 1998 (1998 Act) on 29 July 2024 disputing liability for resin replacement on some teeth on the basis that dental work is not causally related to the
12 October 2021 injury, and for the requested crowns or veneers on the basis that the treatment is not reasonably necessary as a result of the injury. Liability was accepted for resin replacement of teeth 12 to 23 only.
The second s 78 notice issued on 4 October 2024 disputes the requested treatment of extraction of upper right and left molars and a lower left molar, and fixed appliances for six teeth, as it has not been clearly identified as reasonably necessary to the recovery from the workplace injury.
The applicant made submissions to the insurer on 16 December 2024 and following internal review the dispute was maintained on 31 December 2024.
The applicant lodged an Application to Resolve a Dispute (ARD) with the Personal Injury Commission (Commission) on 7 July 2025 claiming future medical or related expenses estimated at $50,000 for dental treatment expenses.
The dispute was listed for conciliation conference and arbitration hearing on
22 September 2025.

ISSUES FOR DETERMINATION

The parties agree the issue in dispute is whether the dental treatment proposed by Dr Hooi and Dr Jimenez is reasonably necessary as a result of injury on deemed date of injury
12 October 2021 pursuant to s 60 of the Workers Compensation Act 1987 (1987 Act).

PROCEDURE BEFORE THE COMMISSION

The parties appeared for conciliation conference and arbitration hearing on
22 September 2025 in Sydney. On the application of Mr Muhamed Ziedi, psychologist, approval was given for the applicant to attend via audio visual link (MS Teams). Mr Paul Stockley of counsel appeared for the applicant instructed by Ms Megg Ross, legal practitioner. Ms Lyn Goodman of counsel appeared for the respondent instructed by Ms Cherie Tippett, legal practitioner, and Mr Masuvu was also present.
During conciliation the respondent’s Application to Lodge Additional Documents dated
18 September 2025 was admitted.
I am satisfied 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 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

The following documents were in evidence before the Commission and considered in making this determination:
(a)    ARD and attached documents;
(b)    Reply and attached documents; and
(c)    respondent’s Application to Lodge Additional Documents dated 18 September 2025 and attached document (ALAD).

Oral evidence

13. No application was made to adduce oral evidence.

Applicant’s evidence

The applicant relies on his signed statements of 2 August 2024 and 13 February 2025.
The statement dated 2 August 2024 was prepared in support of the applicant’s claim for a secondary dental injury resulting from a primary psychological injury that occurred on or about 12 October 2021 while he was employed by the respondent.
After several years of not visiting a dentist the applicant began attending Sydney Park Dental as a patient of Dr Isabelle Ahn in 2020, initially requiring a few fillings and a root canal treatment. His oral health was stable after this treatment and he only required routine dental checkups and cleans.
The applicant developed an eating disorder as a result of the workplace psychological injury which led to damage to his teeth.
Dr Ahn noted the appearance of acid wear although the applicant did not initially disclose his binge-purging behaviour due to embarrassment. He eventually informed her, expressing his concerns about its impact on his dental health as he was experiencing increased sensitivity and occasional pain.
He was advised on minimising the effects of the eating disorder on his teeth including using Tooth Mousse Plus, rinsing with bicarbonate of soda and water after purging and consulting a prosthodontist.
The applicant on reflection believes a period of alcohol abuse, a consequence of his psychological injury, also contributed to his dental injury. During that time he frequently consumed sweet or carbonated alcoholic drinks, and intoxication often led to neglecting his oral hygiene routines such as brushing his teeth.
In his supplementary statement of 13 February 2025 the applicant says his mouth feels healthier overall since getting his disordered eating under control and being cared for by the right specialists.
He has developed a new issue as the position of his teeth has changed causing rubbing and accidental biting on the inside of his cheeks. That was not a problem before and is uncomfortable and frustrating to deal with.
The resin restorations currently in place he has been told by his prosthodontist were only ever meant to be temporary and they are chipped and worn in some areas. Every time he eats or talks he feels really anxious because he is worried about causing more damage.
They are also visibly different from his natural teeth with a distinct line where they meet, which is embarrassing. The applicant is very self-conscious when he opens his mouth because he worries other people will notice the difference.
His teeth hit together with noticeable force when he eats, chews or sometimes just when he talks, which is a strange and unsettling feeling. This scares him because he knows the resin restorations are not strong enough for the impact and he constantly worries they will crack or break even more, making the situation worse.
The treatment plan is complicated and the independent and treating specialists do not agree on everything. When the applicant met with Dr Churchin in person Dr Churchin explained he supported the overall treatment plan, the only difference being the materials to be used for the restorations.
Dr Churchin also told him months ago that the delays in approving the treatment had already caused further deterioration, which makes the applicant feel like the insurer just does not care what happens to his teeth, and it is hard to trust anyone after being left in this position for so long.
The applicant is constantly worried about his teeth, the resin restorations failing, his teeth getting worse and what the damage will look like if this keeps dragging on. The temporary fix is getting weaker by the day.
The treatment means the applicant can get back to feeling like himself again. He just wats to be able to eat, talk and smile without worrying that his teeth might break and people will notice the damage caused by something he has already worked so hard to overcome.

Dr Ken Hooi, treating prosthodontist

Dr Ahn referred the applicant to Dr Ken Hooi on 11 August 2022.
Dr Ahn confirms the applicant has attended Sydney Park Dental since 2020 and has presented for regular check-ups since. In the last 12 months or so there were obvious acid erosion lesions on palatal surfaces and it has become apparent he has reflux and suffered from eating disorders in the last year which are the most likely cause of the acid wear. The teeth have significant thinning of enamel. Dr Ahn recommended the applicant see a prosthodontist for appropriate restoration of the worn teeth due to its complexity.
On 3 December 2023 Dr Hooi reports to Sydney Park Dental after having seen the applicant on seven occasions since February 2023. Dr Hooi takes full responsibility for unexpected delays in finalising the treatment plan and he provided some initial treatment without requesting payment as a result.
The applicant presented with severe localised tooth surface loss with likely risk factors including chemical (GORD, Bulimia), parafunction (grinding) and occlusal scheme (early to moderate-severe wear of 11 teeth). Treatment objectives were defined and agreed on the referral of the applicant to Dr Jimenez, who is aligned with the proposed treatment.
Management options comprise aesthetic and occlusal reorganisation. The essence of the problems are the tooth surface loss and associated decline in dentofacial aesthetics and destabilisation of his occlusion. One option including full coverage indirect ceramic restorations is not preferred.
The other option is orthodontic treatment to reverse the effects of occlusal destabilisation with full coverage indirect ceramic restorations, which is less invasive and fulfills all treatment objectives.
Dr Hooi referred the applicant to Dr Jimenez for consideration of the applicant’s aesthetic and occlusal objectives from an orthodontic perspective, and planning has taken place with Dr Hooi, Dr Jimenez and Dr Ahn.
An itemised treatment plan is attached to Dr Hooi’s report with total fees of $25,774.
On 10 March 2024 Dr Hooi provides his response to Dr Sotiropoulos’ recommendations in his supplementary report. Dr Hooi summarises Dr Sotiropoulos’ plan as flawed, first as occlusal splint management is not reasonable at this time as the existing occlusal scheme is not stable and could exacerbate the applicant’s GORD. A formal approach including occlusal reorganisation and active monitoring of saliva function should precede any occlusal splint management.
Another reason is that remineralising techniques assume known salivary hypofunction is contradictory to any simultaneous occlusal splint management.
Dr Sotiropoulos appears to assume the applicant’s occlusal scheme is stable however it is not. While Dr Sotiropoulos accepts a state of tooth surface loss he appears to oversimplify the complexity of the case in Dr Hooi’s opinion.
Dr Hooi’s response is to reject this opinion and instead pursue the opinion of a general dentist who can identify the scope of services required to assess the case, or at least identify the complexity of the case and refer to appropriate dental specialists. Alternatively the applicant could be referred directly to a prosthodontist and/or orthodontist for an independent medical examination to replace or complement Dr Sotiropoulos’ supplementary report.
On 9 December 2024 Dr Hooi provides a medico legal report. The treatment plan he recommends satisfies all treatment objectives including most relevantly to control and eliminate the disease. Improving dentofacial aesthetics is a necessary component of restoring health. Optimising longevity of the natural and restored dentition are also necessary in restoring health, and his is the most appropriate and conservative management plan characterised by aesthetic and occlusal reorganisation. Dr Hooi reviews three alternative treatment plans.
On 25 May 2025 Dr Hooi provides a supplementary medico legal report. The applicant’s dental presentation would not have occurred in the absence of his work-related eating disorder and he explains how that contributed to his presentation. There are no other factors that may have contributed to the applicant’s dental conditions.
The treatment plan characterised as aesthetic and occlusal reorganisation utilising orthodontic and prosthodontist management is the most appropriate for the applicant. The composite resin restorations in situ were never intended to perform as definitive restorations as they are not durable.
In a further medico legal report dated 30 June 2025 Dr Hooi says the crowns and/or veneers are needed to restore tooth structure which has been lost as a result of acid erosion and he maintains his recommendation for the applicant’s treatment plan.

Dr Vanessa Jimenez, treating specialist orthodontist

Dr Jimenez reports on 25 July 2024 the applicant was referred to her for pre-restorative orthodontics with a history of eating disorder, major depressive disorder with anxious distress and complex post-traumatic stress disorder.
As part of the applicant’s comprehensive treatment plan extraction of upper right molars (18, 28, 38 and 48), upper right and left supernumerary third molars (19, 29 and 39) and lower left supernumerary third molar (30) is required.
On 19 September 2024 Dr Jimenez confirms the pre-restorative orthodontic treatment is necessary to move the affected teeth back into their original position so Dr Hooi can restore them. She lists the teeth affected by the eating disorder that caused enamel erosion, severely affecting their palatal surfaces. As a consequence of the acidic erosion there is no vertical space to restore the affected teeth which is why orthodontic treatment is necessary. Full fixed appliances are required to reestablish the lost vertical dimension. The full cost of orthodontic treatment is $10,800.
On 10 February 2025 Dr Jimenez provides a medico legal report. She comments that Dr Hooi’s recommended treatment plan aims to control and eliminate the disease by improving dentofacial aesthetics and function and optimising the longevity of the dentition. This requires reestablishing the vertical relationship between upper and lower anterior teeth and creating enough vertical space for future restorative work that preserves the dental structure remaining after injury.
While the occlusal findings are pre-existing and not related to the injury there is clear evidence the anterior occlusion has changed as a consequence of the significant loss of palatal and incisal teeth structure associated with the eating disorder.

Dr John Churchin, independent prosthodontist

Dr Churchin provides an independent medico legal report to the respondent on 20 May 2024.
The applicant has been diagnosed with an eating disorder which can result in acid wear or erosion of the teeth, and he has erosion of the palatal surfaces of the upper anterior teeth.
Treatment to date has been temporary resin restoration of the affected teeth and referral to an orthodontist as part of a longer term plan to restore the lost tooth structure.
Dr Churchin’s opinion is there is erosion of the palatal surfaces of teeth 13-22, and given the history the source of the erosion was more than likely gastric acid and the cause of the erosion was the patient’s eating disorder.
The diagnosis made is loss of palatal tooth structure 13-22 as a result of erosion. While the applicant’s oral presentation has been somewhat masked by the resin addition placed by Dr Hooi, the pre-treatment photos would support that diagnosis.
There is no pre-existing dental condition that would explain the erosive tooth loss, ruled out by saliva tests carried out by Dr Hooi.
Dr Hooi’s plan is reasonable and Dr Churchin’s only modification would be replacing the full coverage restorations once orthodontic treatment is completed with replacement of the current resin replacement of lost tooth structure. Full coverage of the teeth would necessitate removal of more tooth structure to accommodate the restoration. The resin restorations may require a little more maintenance over the patient’s lifetime.
On 3 June 2025 Dr Churchin provides a supplementary report commenting on the reports of Dr Hooi and Dr Jimenez. He does not change his opinions regarding cause and treatment.
Dr Hooi comments, as Dr Churchin notes, that Dr Churchin does not consider dentofacial aesthetics nor longevity in his decision on the preferred treatment. The damage from erosion was not of an aesthetic nature but of a structural nature. Resin will replace the lost tooth structure once the space is created orthodontically. One of the issues with placing ceramic restorations, apart from the need to reduce sound structure, is the potential for excessive wear of the lower anterior teeth as a result of tooth grinding. The use of a splint is a recommended part of the plan to help address this possibility, but it relies on patient adherence to use of the splint essentially forever.

Dr Zhen Zhang, treating psychiatrist

On 8 November 2022 Dr Zhang agrees the applicant has developed symptoms consistent with Bulimia Nervosa, and he first developing eating issues in 2021 in the context of workplace stress. Binge eating and purging behaviour gradually got worse and ‘out of control’, occurring sometimes several times a day.
There is a causal relationship between workplace stress and the applicant’s eating disorder.
The applicant may need referral to a psychiatrist specialising in treating eating disorders.

Dr Sian Ong, treating psychiatrist

On 6 June 2023 Dr Ong reports on an initial assessment of the applicant in relation to his eating disorder.
Dr Ong provides a differential diagnosis of Bulimia Nervosa and Other Specified Eating Disorder and recommends a series of treatments.

Dr Ken Hooi clinical notes

Dr Hooi’s clinical notes date from 6 February 2023 and will be referred to where relevant.

Certificate of Determination – Consent Orders 4 June 2025

The application to resolve a dispute in Commission proceedings W2352/25 was discontinued on 4 June 2025.

Respondent’s evidence

Dispute notices

The s 78 notice of 29 July 2024 and the s 287A internal review outcome notice of
31 December 2024 are relied on by the respondent.

Dr Georgios Sotiropoulos, independent dental surgeon

Dr Sotiropoulos reports on 17 January 2024 following an examination of the applicant that his clinically evident substantive conditions appear to be chronic aetiology and likely consequential to pre-injury causation given the relative recent date of work injury, however Dr Sotiropoulos is guarded in this position given the absence of any pre or post-injury dental records and radiographs.
The treatment plan of Dr Ahn, Dr Hooi and Dr Jimenez is reasonable and necessary addressing the evident dental conditions, however it is not consequential to the work injury.
Dr Sotiropoulos carries out a file review on 19 February 2024. Having viewed photographs the doctor agrees the palatal lesions at 13-23 have the appearance consistent with having experienced marked palatal tooth structure loss due to several factors including pre-existing occlusal and orthodontic causations, which appear to have been acutely exacerbated by work injury gastric reflex/eating disorder erosion.

Other aspects of the proposed treatment plan seek to address, and are essentially consequential to, pre-existing orthodontic, occlusal and aesthetic considerations. Dr Sotiropoulos, referring to Dr Jimenez’s report, believes all but the significant enamel erosion associated with an eating disorder are inarguably pre-existing contributory conditions.
The direct restorations at teeth 14-23 that have been already done are consequential to the recent gastric reflux caused by work injury and should be reimbursed in the doctor’s opinion.
The treatment suggested is occlusal splint management with regular prophylaxis and preventive care with remineralising techniques such as tooth mousse topical home application/delivery systems, considered as consequential to the work injury.
Dr Sotiropoulos does not agree with the proposition of veneers/crowns as the most suitable treatment option consequential to the workplace injury.
On 29 May 2025 Dr Sotiropoulos provides a supplementary report following a review of the Sydney Park Dental clinical notes.
The clinical evidence confirms his opinion that substantive conditions appear to be chronic in aetiology and likely consequential to pre-injury causations given the relative recent date of injury. He notes the record made on 17 June 2020 including of multiple decays and holes but no pain at the moment, with crowding and hyperdontia (the presence of extra teeth).
Dr Sotiropoulos provides a further file review on 27 August 2025. He confirms his view that the applicant’s clinically evident substantive conditions appear to be chronic in aetiology and likely consequential to pre-injury causations given the relatively recent date of the work injury, however he did not have dental records or radiographs.
The injury on 12 October 2021 made no material contribution to the need for treatment and the treatment is not reasonably necessary considering appropriateness, availability of alternative treatment, the cost, or its effectiveness.
In relation to acceptance by medical experts, Dr Sotiropoulos comments there is likely to always be healthy disagreement depending on the degree of experience/training familiarity with recent tooth conserving/additive restorative techniques, and an individual practitioner’s philosophy and motivation.
In Dr Sotiropoulos’ opinion the treatment planned is not substantially due to any alleged work injury. The occlusal splint is more applicable due to the applicant’s unsatisfactory occlusal scheme. Remineralising techniques being contraindicated in the absence of confirmation of stable saliva function is a ludicrous proposition, and Dr Sotiropoulos notes the absolute universal acceptance and importance of remineralising in the maintenance and/or treatment of tooth structure.
Dr Sotiropoulos agrees with Dr Jimenez’s conclusion that there were occlusal findings not related to the injury and that is evidence that anterior occlusion has changed as a result of significant loss of palatal and incisal tooth structure associated with the eating disorder.
Historic loss of posterior teeth has inevitable wear consequences to the dentition. Referring to orthodontic/occlusal irregularities consequential to historic and premature loss of 26 and 15, Dr Sotiropoulos comments that this loss of support is the most likely cause of resultant anterior wear, and is likely further exacerbated by acid wear rendering these areas more friable.
The doctor has not been presented with any evidence regarding the appearance of the applicant’s teeth prior to the injury, and ‘dentofacial aesthetics’ is likely a cosmetically driven issue associated with existing conditions.
The composite resin restorations have definitely not caused bilateral posterior open bite, and Dr Sotiropoulos does not agree that replacing resin restorations with porcelain crowns is the preferred treatment option. He comments that crown provision is invasive and would necessitate further tooth destruction, and increases the restorative burden placed on the patient going forwards. Composite restorations are tooth conserving and additive in nature.

Dr John Churchin, independent prosthodontist

The respondent relies on the reports of Dr Churchin dated 20 May 2024 and 3 June 2025 discussed above.

Sydney Park Dental clinical notes

The records of Sydney Park Dental with photographs date from 17 June 2020 to
11 April 2025 and will be referred to where relevant.

Applicant’s submissions

The applicant made oral submissions which have been recorded and form part of the Commission’s record. These are set out below.

There are three components to the claim. Liability has been accepted for the restoration basically of teeth 12 to 23 and that work has been undertaken and reimbursed.
Outstanding matters are the question of extractions and the application of orthodontic braces in preparation for the application of crowns.
Dr Hooi’s reports include a table with the work to be carried out and the cost, and perhaps the clearest argument Dr Hooi presents in support of those items is contained in his report of 25 May 2025.
Comparing the items in his table with the arguments he presents raises a discrepancy and presents a forensic problem for the applicant. The first two items in the Itemised Treatment Plan for Professional Services in Phase 2 Control and Conservation are adhesive restoration and restoration of incisal corner of tooth number 32, however there is no argument made about treatment to tooth 32.
The teeth that are identified are teeth 12 to 23 in respect of which there has been a concession of liability so this tooth is an outlier in terms of the claim.
Dr Jimenez has identified the teeth for extraction, but the need for which cannot be said to relate to the injury itself. There is no expert opinion expressed on the need for extractions other than for the restorative process of 29, 39 and 38 are supported as requiring extraction for the restorative process, as that relates to the injury itself and restoring the applicant’s dentition to its pre-injury state.
Dr Churchin discusses simply restoring using resin, which is the present situation. Dr Hooi responded to this opinion saying the interim composite resin restorations have knowingly caused an opening between the upper and lower back teeth on both sides, a ‘bilateral posterior open bite’, and they may become worn or defective, as has recently become the case with the front right unit.
The treatment for this is the orthodontic treatment recommended by Dr Jimenez to resolve the bilateral posterior open bite and Dr Hooi intends to remove the interim composite resin restorations and replace them with porcelain crowns.
The interim composite resin restorations will inevitably wear or chip, exposing the back surfaces of the front teeth, putting the applicant back in the same position he was in prior to the resin restorations. This is why they are not a permanent solution.
Dr Hooi says porcelain crowns are preferred over porcelain veneers as these are likely to chip or fall out due to the lack of enamel for the porcelain to bond to the dentine at the worn back surfaces of the front teeth. They would also not look good after a few years as a stained line could appear where the porcelain veneer meets the tooth.
Porcelain crowns will prevent the further loss of tooth structure and the appearance of the front teeth will be restored back to the pre-injury state.
The applicant submits there is a necessity for treatment to return the applicant to his pre-injury state, and that is the opinion offered by the treating prosthodontist.
The burden of establishing the treatment is reasonably necessary on the principles of Rose and Diab is on the balance of probabilities well and truly discharged by the applicant, and there is a reasonable necessity of the porcelain crowns.

Respondent’s submissions

The respondent made oral submissions which have been recorded and form part of the Commission’s record. These are set out below.
There are three aspects of the treatment plan that has been devised for the applicant; the extractions, then the orthodontic braces and then to finish it off the crowns versus veneers versus restorations.
In relation to the extractions the respondent has worked with a dental chart from the internet. The applicant’s teeth 13 to 23, the middle of the front teeth of the upper jaw, have been affected by gastric acids. There is no dispute about that and the respondent has already paid for resin restorations of those teeth.
Dr Jimenez deals with the teeth that are in effect standing in the way of the orthodontic braces that will need to be fitted. The extractions are in respect of two supernumerary teeth, tooth 29 which is in between 27 and 28, and on the same side tooth 39, above 37 and 38. The extraction of these two supernumerary teeth is not really as a result of the injury but to secure and anchor the braces.
Dr Jimenez also talks about tooth 38, just below the supernumerary tooth, that she refers to as having been impacted and perhaps growing sideways.
The respondent agrees to pay for that tooth as well. They are the three extractions that are not controversial. They are not specifically caused by the injury, supernumerary teeth just grow by themselves, however they are required to anchor the braces and that is why those three teeth need to be extracted.
There are other teeth Dr Jimenez has spoken about which need extraction but it is the respondent’s position that those teeth are not in fact related to the injury and Dr Jimenez seems to accept that.
The braces it seems are necessary. Dr Jimenez refers to the necessity of the braces and how they are going to assist, and Dr Churchin agrees the applicant needs that treatment.
The other aspect that is more controversial is what happens after the braces.
Once the applicant’s teeth have settled down and the braces have done their work there has to be some restoration of the teeth and the issue then is whether it is to be done by way of crowns, which is really top of the model as it were, or should it be done by way of veneers whether porcelain or other veneers, or should it be done by way of resin replacement or restoration which is similar to what the applicant has already had but it is over restored teeth and these are full restorations.
Dr Churchin in his report of 20 May 2024 under the heading ‘Opinion’ says the erosion on the palatal surfaces of teeth 13 to 22 and given the history the source of erosion was more than likely gastric acid and the cause of the erosion was the patient’s eating disorder. Dr Churchin says the applicant’s oral presentation has been somewhat masked by the resin additions placed by Dr Hooi, however pre-treatment photos would support the aforementioned diagnosis.
In answering a number of questions Dr Churchin refers to the treatment plan suggested by Dr Hooi and says the plan is reasonable. Dr Churchin then says his only modification would be replacing the full coverage restorations once orthodontic treatment is completed with replacement of the current resin replacement of lost tooth structure.
Full coverage of the teeth would necessitate removal of more tooth structure to accommodate the restoration. The resin restorations may require a little more maintenance over the patient’s lifetime.
In his report of 3 June 2025 Dr Churchin has reviewed further reports of Dr Hooi and Dr Jimenez and he has not changed his opinions regarding the cause or treatment options.
Dr Churchin notes that Dr Hooi talks about there being no consideration for dentofacial aesthetics nor longevity in his decision on the preferred treatment.
Dr Churchin says the damage sustained from the erosion was not of an aesthetic nature but of a structural nature. Resin will replace the lost tooth structure once the space has been created orthodontically.
One of the issues with placing ceramic restorations, apart from the need to reduce sound structure, is the potential for excessive wear of the lower anterior teeth, so he is giving a reason for his opinion why it is better not to use porcelain or ceramic restorations but to use resin instead, because of the wear on the lower teeth as a result of nighttime grinding. Dr Churchin says a splint is a recommended part of the plan to help address this possibility.
The respondent’s submission is the applicant’s dentition according to the doctors was not good prior to the injury so that when restorations and so on are being done that needs to be taken into account as well.
Dr Sotiropoulos says the substantive conditions clinically evident appear to be chronic in aetiology and likely, based on the available evidence, consequential to pre-injury causation given the relatively recent date of the work injury. He is guarded in that position however given the absence of any pre or post injury dental records and radiographs.
Asked whether any of the teeth requiring treatment have been completely unaffected by the injury, Dr Sotiropoulos says he does not believe the treatment planned is substantially due to any alleged work injury.
Dr Sotiropoulos then talks about an occlusal splint and he says that is more applicable due to the applicant’s unsatisfactory occlusal scheme rather than any injury per se.
Historical loss of posterior teeth has inevitable wear consequences to the dentition. Dr Sotiropoulos then notes the applicant has had premature loss of 26 and 15, so the applicant had a loss of teeth even prior to the injury. This loss of support is in his opinion the most likely cause of resultant anterior wear and is likely further exacerbated by acid wear rendering these areas more friable.
When asked whether porcelain crowns is the preferred treatment it is a resounding no. Dr Sotiropoulos describes crown provision as invasive and this would necessitate further tooth destruction, increasing the burden placed on the applicant going forward, so he certainly does not recommend crowns.
Composite restorations are tooth conserving and additive in nature.
Both the respondent’s doctors suggest perhaps not crowns, not veneers, but once the orthodontic treatment is completed to preserve the teeth they suggest resin restoration. Dr Churchin talks about full coverage resin restorations and Dr Sotiropoulos says they are both tooth conserving and additive in nature.
The respondent’s submission is that you would accept that it is not necessary for the applicant to have the crowns once the orthodontic treatment is completed, and that in fact resin restoration, like the applicant has already had, is the preferred way to go, mainly because there is no additional tooth loss which quite clearly happens when a crown is placed on a tooth, and veneers are not as good as resin restoration.

Applicant’s submissions in reply

The question of whether the proposed treatment is reasonably necessary is straightforward. There is a difference of clinical opinion between Dr Hooi and Dr Churchin but that is not the question. The question is whether the proposed treatment is reasonably necessary, and it does not matter that doctors take a different approach.
Some criticism was made of the reference by Dr Hooi on causation and the restorative treatment he proposes. The applicant’s statement makes clear the problem is the resin is different to his teeth and this is not a cosmetic issue.
Dr Hooi also does not support the use of a splint, as he says in his report of 10 March 2024.

FINDINGS AND REASONS

Is the dental treatment proposed by Dr Hooi and Dr Jimenez reasonably necessary as a result of injury on deemed date of injury 12 October 2021

Section 60 of the 1987 Act provides for the payment by an employer of the cost of any reasonably necessary medical or related expenses received by a worker as the result of an injury in addition to any other compensation payable under the Act.
The legal test when determining whether proposed treatment is reasonably necessary as a result of a workplace injury was considered by Roche DP in Diab v NRMA Limited[1] at [86];
“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.”
[1] [2014] NSWWCCPD 72 (Diab).
In Diab Roche DP cites the decision of Burke CCJ in Rose[2] with approval. While the essential question remains whether the treatment is reasonably necessary, the following are useful heads for consideration:
(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.[3]
[2] Rose v Health Commission (NSW) [1986] NSWCC 2; (1986) 2 NSWCCR 32.
[3] at [88].

There is agreement between the parties that the extractions of supernumerary teeth 29 and 39, and of 38 which is horizontally impacted, the full fixed appliances to teeth 13, 12, 11, 21, 22 and 23 to realign the teeth to suitable occlusal and aesthetic positions to match the pre-injury state, as well as restoration of the tooth structure lost as a result of acid erosion, is reasonably necessary medical or related treatment.
The issue in dispute is whether the restoration of the affected teeth listed by Dr Hooi as 14, 13, 12, 11, 21, 22 and 23[4] should be by way of full crowns as he proposes, or by resin restorations as proposed by Dr Churchin.
[4] ARD page 31, 35, 43
A range of different treatments may qualify as reasonably necessary treatment. There is evidence that restorations by way of the application of crowns, veneers or resin replacements are potentially reasonably necessary treatment. The applicant is only required to establish that the treatment proposed by Dr Hooi being the application of crowns is one of those treatments.[5]
[5] Diab at [86].
Dr Hooi prefers porcelain crowns over porcelain veneers as porcelain veneers will likely chip or fall out due to the lack of enamel for the porcelain to bond to the dentine at the worn back surfaces of the applicant’s front teeth. Porcelain veneers would also not look good after a few years as a stained line could appear where the porcelain veneer meets the tooth.
Dr Hooi explains the crowns are needed to restore tooth structure which has been lost as a result of acid erosion.[6]
[6] ARD page 56.
Dr Hooi recommends full coverage indirect ceramic restorations on the following bases;
a)    this fulfills the treatment objective of improving dentofacial aesthetics,
b)    this fulfills the treatment objective of optimising longevity of natural and restored dentition,
c)     restoring with crowns will prevent further loss of tooth structure,
d)    the appearance of the applicant’s teeth will return back to the pre-injury state,
e)    it will result in a long term stable aesthetic, and
f)     it will satisfy the aesthetic objectives for the longer term with potential cycles of 15 to 20 years (less dental treatment in the future).
Dr Churchin’s opinion is that full coverage of the teeth would necessitate removal of more tooth structure to accommodate the restoration. Dr Sotiropoulos agrees that porcelain crown provision is invasive and would necessitate further tooth destruction.
While necessitating loss of further tooth structure, Dr Hooi’s and Dr Jimenez’s treatment plan provides a longer term solution for repair of damage to the applicant’s teeth resulting from the workplace injury.

I place less weight on Dr Sotiropoulos’ opinion as in his view the restorative burden placed on the applicant is increased. While this may be the case in the shorter term, Dr Sotiropoulos does not address Dr Hooi’s opinion that the revision cycle will be less with the application of crowns as compared with resin restorations.

Dr Churchin’s opinion is that there is the potential for excessive wear of the lower anterior teeth as a result of tooth grinding. While use of a splint is not recommended while the applicant’s teeth have not been stabilised through orthodontic treatment, Dr Hooi’s view is that occlusal splint management may be indicated to moderate the effects of parafunction during maintenance in the applicant’s post-treatment era and once his occlusal scheme is stable.
Dr Churchin comments that while a splint may address the possibility of wear from night tooth grinding, it relies on patient adherence to the splint’s use essentially forever. The applicant’s statement evidence supported by Dr Ahn is that he has maintained good oral hygiene since 2020, effectively looking after his teeth since the restorative work was completed.
Dr Churchin prefers replacement of the current resin replacement of lost tooth structure, although resin restorations may require a little more maintenance. Dr Sotiropoulos’ opinion is that composite restorations are tooth conserving and additive in nature.
Dr Hooi predicts problems however with utilising resin restorations as the definitive restorations due to longevity, stability and the aesthetic outcome.
In Dr Hooi’s opinion temporary resin restorations are not durable and will not result in pre-injury appearance. They will inevitably wear or chip, and the revision cycle of composite resin restorations is greater than the revision cycles of porcelain crowns. Revision could be up to 11 cycles through the applicant’s life.
It would be necessary to extend resin restorations beyond the incisal edge as part of reclaiming the pre-injury aesthetic of the affected teeth Dr Hooi says, and structural failure through chipping, delamination or even further tooth surface loss could occur within five years.
Physical wear of the restorations could also trigger another episode of dentoalveolar compensation, effectively reversing the effect of any orthodontic treatment.
Dr Hooi’s opinion is supported by the applicant’s statement in which he describes the temporary resin restorations as chipped and worn in some areas and visibly different from his natural teeth, causing him anxiety and embarrassment. He is very self-conscious that the difference will be noticed.
I prefer Dr Hooi’s opinion as the applicant’s treating prosthodontist and on consideration of the principles discussed in Rose and Diab.
Restoring with full-coverage all-ceramic restorations is appropriate and effective treatment in Dr Hooi’s opinion and he sets out his reasoning for preferring the application of crowns to the use of resin replacements. The application of crowns provide a longer term solution and will potentially place the applicant into the pre-injury state.
I am not persuaded by Dr Churchin’s and Dr Sotiropoulos’ views opposing the application of crowns on the basis of the necessity of removal of more tooth structure and the potential for excessive wear of the applicant’s lower anterior teeth as discussed above.
I prefer Dr Hooi’s opinion that resin restorations are not durable and will not result in pre-injury appearance.
No submissions have been made on the cost of the proposed treatment plan.
For the respondent to be liable for the costs of the proposed treatment the applicant must establish the accepted injury materially contributes to the need for that treatment.[7] The evidence is that the accepted injury materially contributes to the need for the proposed treatment, including restoration of the affected teeth with the application of crowns.
[7] Murphy v Allity Management Services Pty Ltd [2015] NSWWCCPD 49 (Murphy).
Reasonably necessary medical or related treatment as a result of an injury must be assessed on a case by case basis, with the Commission exercising ‘prudence, sound judgment and good sense’.[8]
[8] Rose at [47].
I find in this case the treatment plan proposed by Dr Hooi and Dr Jimenez including restorations of the applicant’s affected teeth by the application of crowns is reasonably necessary medical or related treatment.
The applicant is entitled to payment of the costs of the treatment plan proposed by Dr Hooi and Dr Jimenez including the application of crowns to his affected teeth pursuant to s 60 of the 1987 Act.

SUMMARY

The dental treatment proposed by Dr Hooi and Dr Jimenez is reasonably necessary medical or related treatment as a result of injury on deemed date of injury 12 October 2021 pursuant to s 60 of the 1987 Act.
The applicant is entitled to payment of the costs of the proposed dental treatment plan proposed by Dr Hooi and Dr Jimenez including the application of crowns to his affected teeth pursuant to s 60 of the 1987 Act.

[2025] NSWPIC 563

21 October 2025