Consequential conditions – circumstances where a diagnosis is required

In the recent case of Grant v Dateline Imports Pty Ltd [2022] NSWPICPD 3, on appeal, Deputy President Wood confirmed the worker must have evidence of a diagnosis in support of an alleged consequential condition. The presence of symptoms, rather than a diagnosis, was insufficient to support a finding of consequential injury.

Facts

On 31 July 2015, the worker injured his right upper extremity at work and the insurer accepted liability for the injury. The worker subsequently alleged suffering consequential pain in his left upper extremity as a result of overuse in favouring his injured right arm, and a consequential complex regional pain syndrome (CRPS).

Several years later the worker claimed lump sum compensation under section 66 of the Workers Compensation Act 1987 (the 1987 Act) for injury to both upper extremities and CRPS – alleging consequential left upper extremity injury. The insurer disputed liability for the alleged consequential condition of the left upper extremity.

The worker subsequently commenced proceedings claiming lump sum entitlements pursuant to section 66 of the 1987 Act in respect of the permanent impairment of his right upper extremity, left upper extremity and CRPS.

At first instance before the Commission, Principal Member Bamber referred to the worker’s statement and acknowledged there were references to the worker having used his left (dominant) arm more because of the right arm injury but the Principal Member observed there was no clear diagnosis for the left arm complaints provided by the treating doctors.

The Principal Member did not consider the worker had discharged the onus of proof and was not persuaded of the existence of a condition in his left arm through overuse. Further, she accepted the respondent’s submission the worker’s left arm was his dominant arm. Thus, Principal Member stated for the worker to satisfy the Commission he suffered a consequential left arm condition he needed to provide the following specific evidence:

  • factual support for the tasks which the worker claims caused the overuse

  • expert opinion considering the evidence of overuse and diagnosing a condition resulting from the overuse in the left upper extremity.

Decision

On 16 April 2021, Principal Member Bamber determined the worker did not suffer a consequential condition in his left upper extremity. The issue of whether there was a rateable diagnosis of CRPS was considered a matter for medical assessment, and remitted the President for referral to a Medical Assessor to address impairment of the right upper extremity and any CRPS affecting that extremity.

On appeal, the worker argued the Principal Member erred as follows: 

  1. in finding as a matter of law a “diagnosis” was needed to determine if a consequential injury had occurred, and

  2. erred in law in determining the worker’s consequential condition in the left hand bore a higher burden of proof because it was his dominant hand.

Presidential Member Wood did not accept the worker’s argument, that the mere presence symptoms were sufficient to determine the consequential condition resulted from a work injury. In circumstances where there were potential alternate causes (central neuropathic type pain which no doctor attributed to overuse) a diagnosis would be helpful to resolve the inconsistency.

Further, the Presidential Member did not accept the worker’s submission the Principal Member erred in requiring a statement detailing the overuse of the worker’s dominant left arm, and that this bore a higher burden of proof.

Tips

In circumstances where there are multiple or competing causes of a consequential body part, a worker may have to provide evidence of a diagnosis. The worker may also need to provide a detailed account as to how they ‘overused’ their dominant arm having regard to consequential conditions to the opposite arm.

Author: Nina Israil

Contributing partner: Robbie Elder