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- QUBE Ports Pty Ltd v Blackwood (Workers' Compensation Regulator)[2015] QIRC 144
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QUBE Ports Pty Ltd v Blackwood (Workers' Compensation Regulator)[2015] QIRC 144
QUBE Ports Pty Ltd v Blackwood (Workers' Compensation Regulator)[2015] QIRC 144
QUEENSLAND INDUSTRIAL RELATIONS COMMISSION
CITATION: | QUBE Ports Pty Ltd v Simon Blackwood (Workers' Compensation Regulator) [2015] QIRC 144 |
PARTIES: | QUBE Ports Pty Ltd (Appellant) v Simon Blackwood (Workers' Compensation Regulator) (Respondent) |
CASE NO: | WC/2014/203 |
PROCEEDING: | Appeal against decision of the Workers' Compensation Regulator |
DELIVERED ON: | 4 August 2015 |
HEARING DATES: | 16 - 17 October 2014 (hearing) 16 December 2014 (Appellant's submissions) 5 February 2015 (Respondent's submissions) |
MEMBER: | Industrial Commissioner Knight |
ORDERS : |
|
CATCHWORDS: | WORKERS' COMPENSATION - APPEAL AGAINST DECISION - whether injury arose out of or in the course of employment - whether employment a significant contributing factor to the injury – previous history of left knee pain and symptoms not disclosed to WorkCover and treating specialist – whether the worker’s account of this incident at work is credible - the Appellant bears onus of proof - standard of proof – the Appeal is allowed. |
CASES: | Workers' Compensation and Rehabilitation Act 2003 s 32 Croning v Workers’ Compensation Board of Queensland (1997) 156 QGIG 100 Heald v Q-COMP (2004) 177 QGIG 769 JBS Australia Pty Ltd and Q-COMP (C/2012/35) – Decision Kudryavtseva v Simon Blackwood (Workers' Compensation Regulator) [2015] QIRC 053 Momcilovic v R (2011) 254 CLR 1 Newberry v Suncorp Metway Insurance Ltd [2006] QCA 48. Pollock v Wellington (1996) 15 WAR 1 |
APPEARANCES: | Mr C. Clark instructed by Sparke Helmore Lawyers for the Appellant. Ms. D. Callaghan directly instructed for Simon Blackwood (Workers' Compensation Regulator). |
Decision
- [1]This is an appeal by QUBE Ports Pty Ltd ("the Appellant") pursuant to s 550 of the Workers' Compensation and Rehabilitation Act 2003 ("the Act") against the decision of Simon Blackwood (Workers Compensation Regulator) ("the Respondent" / "the Regulator").
- [2]The decision by the Regulator overturned an initial decision by WorkCover rejecting Mr Williams' claim for compensation by Mr Brian John Williams ("the Worker"/ "the Claimant") in respect of an alleged injury to his left knee sustained on 27 March 2014 when he climbed up onto a trailer, pushed off with his left leg and felt his left knee move "sideways a bit and felt a pop and severe pain". The Regulator's decision was that the worker had provided sufficient evidence to support his claim that had an "L medial knee ligament tear and meniscal tear", that the injury arose out of his employment with QUBE Ports Pty Ltd and the employment was a significant contributing factor to the injury.
Grounds of Appeal
- [3]The grounds of Appeal upon which the Appellant relies are as follows:
- (a)Mr Williams did not sustain any injury at work on 27 March 2014 within the application of the Workers' Compensations and Rehabilitation Act 2003;
- (b)Mr Williams' alleged injury on 27 March 2014 did not arise out of or in the course of his employment;
- (c)Employment was not a significant contributing factor to Mr Williams' alleged injury; and
- (d)In particular, the Appellant asserts that the decision maker erred in:
- Failing to give sufficient weight to the following evidence:
- That the Claimant, Mr Williams, was suffering left knee pain from January 2014 and consulted his medical practitioners in this regard;
- An earlier MRI report dated 19 March 2014 was not considered by the specialist Dr Brosnan, and the comparison of that MRI report and a second MRI report conducted on 2 April 2014 relied upon by the decision-maker was made only by the Claimant's treating General Practitioner and not by a specialist;
- The assessing specialist, Dr Brosnan, relied upon a history provided by the Claimant that he had no relevant history of injury to the knee;
- The extent to which the Claimant's weight contributed to his alleged injury; and
- The lack of medical evidence as to the causation of the Claimant's alleged injury, given his weight and the extent of the pre-existing condition and symptoms.
- Failing to properly investigate the claim, by:
- Obtaining and considering copies of the Claimant's treatment notes; and
- Obtaining and considering a medical report from a specialist having regard to the treatment notes and the MRI reports dated 19 March 2014 and 2 April 2014.
- Failing to give sufficient weight to the following evidence:
Issues for Determination
- [4]The appeal to the Commission is by way of a hearing de novo. In order to succeed in its appeal, QUBE Ports Pty Ltd must establish at least one of the following points:
- that at the relevant time Mr Williams did not sustain a left medial knee ligament tear and meniscal tear; or
- that if Mr Williams did sustain a left medial knee ligament tear and meniscal tear that the injury either did not arise out of or in the course of his employment as a stevedore with QUBE Ports Pty Ltd; or was one to which his employment was not a significant contributing factor.
- [5]There is no dispute that Mr Williams is a worker for the purposes of the Act. Nor is there any issue that he has suffered a personal injury in the form of a left medial knee ligament tear and meniscal tear. What is in dispute between the parties is whether or not Mr Williams' injury is a result of his actions of climbing a trailer on the nominated day causing an injury to his left knee which has arisen out of, or in the course of his employment. The Appellant has submitted that Mr Williams already had undergone investigations into his left knee prior to 27 March 2014 and that Mr Williams weight, being 180kgs at the time of the alleged injury, caused or contributed to his alleged injury. The Appellant also submitted that Mr Williams advised the treating specialist he had no history of injury to his left knee.
Relevant Legislative Principles and Authorities
- [6]Section 32 of the Act relevantly provides as follows:
"32Meaning of Injury
(1)An injury is personal injury arising out of, or in the course of, employment if employment is a significant contributing factor to the injury.
…
(3)Injury includes the following -
- (a)a disease contracted in the course of employment, whether at or away from the place of employment, if the employment is a significant contributing factor to the disease;
- (b)an aggravation of the following, if the aggravation arises out of, or in the course of, employment and the employment is a significant contributing factor to the aggravation -
- a personal injury;
- a disease;
- a medical condition if the condition becomes a personal injury or disease because of the aggravation;
(4)For subsection (3)(b), to remove any doubt, it is declared that an aggravation mentioned in the provision is an injury only to the extent of the effects of the aggravation. "
- [7]In Kudryavtseva v Simon Blackwood (Workers' Compensation Regulator),[1] Neate C considered the authorities in so far as they related to onus, noting:
"Although the onus to be discharged is on the balance of probabilities, the Commission, in dealing with the matter, must feel an actual persuasion before the alleged facts can be found to exist. (See MacArther v Workcover Queensland (2001) 167 QGIG 100, 1010 (Hall P) and cases cited). "
And later:
"In a case where expert medical evidence is led, before any such expert medical evidence be of value, the facts upon which it is founded must be provided by admissible evidence (see Coombes v Q-Comp (2007) 185 QGIG 680, 681)."
- [8]
"[27] It cannot be disputed that, when s 32 of the WRC speaks of 'employment' contributing to the worker's injury, it is referring to employment as a set of circumstances, that is to the exigencies of the employment of the worker by the employer. The legislation is referring to 'what the worker in fact does during the course of employment'. "
- [9]As to aggravation of an injury, in Heald v Q-COMP[3], Hall P confirmed the view of Dr Turner that there are two types of compensable aggravation:
"A degenerative condition may be aggravated in the sense that it may be made worse, i.e. after the aggravation the degenerative disorder is worse than it was before. But there can also be an aggravation in the sense of an increase of symptoms associated with a degenerative condition which, after the cessation of the symptoms, returns to its pre-aggravation state. "
- [10]In JBS Australia Pty Ltd and Q-COMP[4] Hall P confirmed the need to establish that "employment must significantly contribute to the occurrence of the injury. It is insufficient to establish that the employment was the setting in which the aggravation occurred or the background to its occurrence. "
- [11]Likewise, in Croning v Workers' Compensation Board of Queensland[5] citing Tophams Ltd v Sefton (1966) 1 All E.R. 1039, de Jersey P held that employment needs to be a "real effective cause" of the injury and not merely the setting or background in which the injury occurs.
Witnesses
Witnesses called by the Appellant
- [12]Mr Gerard Brady works as a Charge Foreman/Team Leader for the employer. He had not witnessed Mr Williams hurting himself at work on 27 March 2014 nor was he aware of any incident where Mr Williams had injured his knee at the workplace. He said that if a worker approached him "hobbling on his knee" advising that he had been injured, he believed that he would have remembered that.
- [13]Mr Christie is a Shift Manager with the employer. He was working on the front end of the vessel on 27 March 2014 when he noticed Mr Williams clutching his left leg. Mr Williams told him he had hurt his knee while trying to climb onto a Maffi trailer. Mr Williams had said when climbing, he had all his weight on his left leg and was twisting when he felt his knee pop. Mr Christie said that he had driven Mr Williams to the first aid room. Mr Williams had told him that Mr Brady and Mr Chambers were witnesses.
- [14]Dr Dela Cruz is a General Practitioner at the Redcliffe Super Clinic. He saw Mr Williams in late 2013 and in January and February 2014. Mr Williams was treated for pain in his knee and issues concerning his weight. In January 2014, X-rays were ordered for Mr Williams' knees and on 12 March 2014, Dr Cruz arranged for an MRI of Mr Williams' left knee. Ultimately two MRI's were undertaken – 19 March 2014 and 2 April 2014.
- [15]Dr Ganko is a specialist Orthopaedic Surgeon. He concentrated on problems associated with the knee. He provided a Medical Report on 8 August 2014. His view was the meniscal tear suffered by Mr Williams could have occurred in a relatively innocuous way. He stated that a discrete tear would have occurred some two weeks before Mr Williams visited his General Practitioner and this would indicate that an incident had occurred in January 2014.
Witnesses called by the Regulator
- [16]Mr Steve Chambers works for the employer and holds the position of an "in-charge foreman" and was Mr Williams' supervisor. He recalled an occasion when Mr Williams said he had hurt his knee at work. Mr Williams had told him that he had heard a popping noise in his knee.
- [17]Mr Brian Williams, the Claimant, was called by the Regulator.
- [18]Dr Brosnan is an Orthopaedic Surgeon. Dr Brosnan saw Mr Williams on 2 or 3 April 2014. The MRI scan of 2 April 2014 had shown a Grade 1 to 2 ligamentous injury of the medial collateral ligament in addition to a tear of the medial meniscus. He stated that between the two scans (19 March and 2 April 2014) something had occurred which resulted in Mr Williams' acute injury and the latter scan showed that the tear had become enlarged. His view was that the injury suffered by Mr Williams constituted an aggravation of a pre-existing condition.
The Evidence
Background to Mr Williams' claim
- [19]Mr Williams is 45 years of age and has worked for the employer since 2004 undertaking the duties of operating machinery, including bulldozers, cranes and crane operations.
The evidence
- [20]On 27 March 2014, Mr Williams' duties for the day involved working as a tug operator unloading "roll on roll off" cargo from a ship. Also on duty that day were Mr Chambers and Mr Brady.
- [21]Mr William's evidence is that he made a decision to unlash a boat from a MAFI trailer. He said he walked up to the side of the MAFI trailer. He recalled the boat had a black handle on the back of it. He said he proceeded to grab the handle and put his left knee up to the side of the MAFI trailer. Mr Williams said he pushed with his right leg and pulled with his hand and then he felt a sharp pain and a 'pop' and severe pain after this. He recalled hobbling around and unlashing the boat. He waited for the forklift and then got in a truck to go back to the deck of the ship to do another load. Once he got there he realized he couldn't put any weight on the left leg and it was at this point that he said he reported his injury to Gerry Brady. After this, he recalled Steve Chambers came and picked him up.[6]
- [22]Mr Chambers' evidence was that someone had told him that between 7:00 and 9:30 am on 27 March 2014 Mr Williams had injured his knee. Mr Williams' evidence was that he advised Mr Brady of the incident and he had called Mr Chambers who came and picked Mr Williams up from the ship deck in his work utility.
- [23]Mr Chambers' evidence was that Mr Williams had injured his left knee when attempting to climb up on to a Maffi trailer. Mr Williams had told him that when his bodyweight was placed on his left leg, he felt his knee pop. He also said that he had all his weight on his left leg when twisting and he then felt his knee pop.
- [24]Mr Williams said this information had been given to Mr Christie who had recorded it on a piece of paper which he told the Commission he subsequently discarded as that information was then recorded electronically by the employer. Mr Williams said he had not told Mr Christie that Mr Brady had witnessed the incident and that Mr Williams had reported the matter to Mr Chambers. Although this had been written in the Incident Report by Mr Christie, that issue was not directly put to Mr Williams in cross-examination.
- [25]Mr Williams' evidence was that he did not author or check these documents and was not provided with a copy when requested by him.
- [26]Mr Williams drive himself to the Redcliffe Hospital on 27 March, 2014 on or around 7.37am on the same morning where the medical entry in his patient record was as follows:
"Stevedore – adjusting lashing – one half metre step up L foot up on trailer and pulling self up and felt knee POP go sideways and gave way. He was stepping up with his left knee half a metre onto a trailer to adjust lashing and he heard a POP medial side of the knee which was painful and the L knee collapsed; he was holding a rail at the time and was able to pull himself up by the arms."
- [27]Mr Williams reported the incident to WorkCover on 28 March 2014. On that form he recorded "Whilst stepping up onto a Maffi trailer employee heard pop in left knee" and "was driving a dock truck (sic) with massey (sic) trailer on the back with a boat on it. Went to unlash the massey (sic) trailer & grabbing the safety rail on the boat, put his left leg on the trailer to get up on top and as he went to push off with his left his left knee seemed to go sideways a bit and he felt a pop and severe pain."
- [28]The Regulator's commentary was that the oral evidence given by Mr Williams was uncontroversial as to how the injury occurred:
"And then proceeded to put my left leg up on to the edge of the MAFI trailer and the right one was still connected to the ground because we'd been informed through safety "thingos" we always had to have three points of contact. So as I was pushing with the right leg and pulling with my hand and as I got to sort of that point where my left knee was taking the weight of all of me, and it sort of, felt a sort of really sharp pain and pop and then sort of a little bit to the side and then severe pain after that and I sort of ended up pulling myself up there with my arm strength, pulled myself up."
- [29]As Mr Williams had not seen the actual report written by Mr Christie. The Regulator expressed concerns about the accuracy of that Report as raised by Mr Williams.
- [30]Mr Christie was questioned by the Regulator as to his identification of the ship on which Mr Williams had been working on 27 March 2014. The Regulator says that Messrs Williams, Chambers and Brady were working on the ship "Endeavour" at Berth 1 while Mr Christie said that the ship was named "Parsifal" at Berth 2. Mr Christie told the Commission it wasn't uncommon, notwithstanding records of locations of ships, for some ships not to be completed within a shift and for employees to be transferred to other ships to assist with unloading on their following shifts.
Medical history concerning Mr Williams' knee
- [31]Mr Williams had made prior workers' compensation claims with his current employer as well as other employers and which had been accepted. It is clear from the evidence he understood that a successful claim would ensure that he was reimbursed for any lost wages and the cost of medical treatment.
- [32]The Regulator made reference to the Appellant's claim that Exhibit 2 established that Mr Williams did not have health insurance. Exhibit 2 (in relation to the Practice Details provided on Redcliffe Super Clinic Records) does in fact record this. However, Mr Williams' evidence was that he did have health insurance and he had already paid for one MRI but there were certain areas of his health treatment that may not be covered by the insurance.
- [33]The Regulator stated that the only expense incurred by Mr Williams prior to his accident on 27 March 2014 had been one prescription for Panadol Osteo and Voltaren 50 and some over the counter Voltaren. The Regulator says that this is consistent with his statement to Dr Brosnan and the contemporaneous records of Dr Cruz
- [34]Mr Williams attended a number of consultations primarily with his General Practitioner, Dr Cruz and also once with Dr Woollons concerning his left knee condition prior to 27 March 2014. Exhibit 2 identifies those consultations as follows:
"24 January 2014 (Dr Cruz)
- "History off (sic) late (2/52) – pain in knee getting worse, more so on starting to get up and walk but better after a while, better with Voltaren. Reason for contact – problem with left knee."
- "Examination – able to squat fully but in pain – negative signs – full ROM, tender over the medial aspect left knee. Actions – x-ray both left and right knees."
4 February 2014 (Dr Cruz)
- "Reason for contact – follow up
- Actions – discussed with patient – results – effusion noted more on the right than the left continue exercises for the knee."
7 March 2014 (Dr Cruz)
- "Reason for contact – problem with left knee – still problem with the left knee – comes back when he stops the Voltaren (OTC 2 tabs TDS), also been taking Panadol Osteo.
- Discuss with patient – knee management
- Actions diagnostic imaging requested: MRI left knee (the 19 March 2014 MRI)"
25 March 2014 (Dr Woollons)
- "Discussed MRI – monitor for now
- Can refer to Ortho if significant symptoms"
- [35]The medical history shows that an X-ray was taken soon after 24 January 2014. Mr Williams said he had not suffered any injury to his knee in January 2014 and there was no evidence to this effect adduced by the Appellant. Under cross-examination, Mr Williams acknowledged he had been on annual leave from 6 January until 12 January, which was around the time that he initially indicated to his GP that he had experienced pain in his left knee. He also acknowledged he was nowhere near work around this time.
- [36]Mr Williams' explanation as to why he had not initially disclosed his prior knee complaints to WorkCover and other treating specialists was that he thought the problems generally related to "wear and tear", and that he had not been advised by any Doctor otherwise. Evidence provided by his GP contradicted these statements to a certain extent in that by March 2014, Mr Williams and his GP were well and truly involved in discussions about locking in an appointment for a MRI and the potential need for a referral to an orthopaedic specialist.
- [37]The Regulator pointed out that Dr Cruz had mentioned the possibility of surgery, but not until such time as the result of the various investigations concerning Mr Williams' knee were known. At the time of the WorkCover claim, the Regulator argued there was no evidence that Mr Williams was facing surgery for his knee.
- [38]An MRI was ordered by Dr Cruz on 12 March, but there had been no record of any further knee complaints on that date and the reason for the visit to Dr Cruz on 12 March was for "Obesity – Morbid". The Regulator says this situation was similar when Mr Williams saw Dr Woollens on 25 March 2014.
- [39]The Regulator states:
"The evidence is consistent with Mr Williams understanding and reporting of his pre-existing knee problem - intermittent pain due to wear and tear, exacerbated by some activities such as unloading car boats, which required use of simple analgesia."
Medical Specialist Evidence
- [40]Dr Ganko's report, dated 8 August 2014, established the MRI of 2 April 2014 showed evidence of an injury which had not been evident from the MRI of 19 March 2014. His notes state: "more significant effusion within the left knee joint" and "more extensive tearing of the body of the medial meniscus." Dr Ganko said that the tear probably extended at the time of the accident on 27 March 2014. While Dr Ganko had not seen Mr Williams he understood the Mr Williams' history of how he had hurt his knee.
- [41]The Regulator's view was that Dr Ganko said that when the two scans were compared, the second scan of 2 April 2014 indicated that an acute injury had occurred around the time of that scan.
- [42]Dr Brosnan personally examined Mr Williams' knee within a week of the incident 27 March 2014 and inspected the knee during arthroscopic surgery on 29 July 2014. Dr Brosnan said that Mr Williams had been in extreme pain when he saw him on 2 April 2014 and could barely walk. He arranged for an immediate MRI.
- [43]The Regulator said that Dr Brosnan's opinion was the scan of 19 March 2014 showed early medial compartment change with possible fraying or small tear of the undersurface of the medial meniscus. The second scan of 2 April 2014 showed signs of an acute injury to the medial collateral ligament and "the tear to the medial meniscus, if that did exist on the first one ….. then that had certainly grown in size or enlarged or became apparent in the second scan….". He stated that the second MRI showed a more significant effusion in the left knee, which indicated an acute event, had taken place.
- [44]The Regulator claims that the difference in opinion between the two medical specialists relates to the difference in interpretation of MRI scans. In contrast to Dr Ganko, Dr Brosnan had the opportunity of examining Mr Williams' knee when the acute pathology was present.
- [45]The Regulator viewed the difference in expertise was not a matter of relevance in this case as both the medical specialists had agreed that the MRI scan after the accident of 27 March 2014 showed an acute injury.
- [46]With regard to Dr Ganko's opinion, the Appellant referred to the opinion expressed by him as to what symptoms the Appellant would have experienced prior to 27 March 2014:
"The type of meniscus tear he had where there is a flap of meniscus that was actually folded beneath the meniscus and then was caught in the recess between the tear and the medial ligament, which is why I believe it was causing the changes in the medial ligament – that type of meniscus tear normally in my experience causes ongoing symptoms or ongoing pain. Now, it's not always disabling to the point where you can't walk or can't sleep or don't do anything, but it causes ongoing symptoms that increase when you put load through the knee, increase when you twist and turn, increase when you try and do sporting activities and – I mean, he had quite a few presentations to his GP and was taking anti-inflammatories and paracetamol and I think the notations ‑ somewhere in the GP notes it sort of said that every time he stopped the inflammatories (sic) his knee flared up and became problematic, and that would be what I'd expect."[7]
- [47]When considering the first MRI which predated Mr Williams' work incident of 27 March 2014, Dr Ganko's view was that there had been a significant medial meniscal tear. He formed this view taking into account the following:
"… in the age of this gentleman who was about 45, I believe, often meniscal tears occur with relatively low velocity trauma. In the younger age group they often take more significant injuries, but a meniscal tear of the nature that he had on that initial scan that was done on the 19th of March could have occurred squatting down, twisting, getting out of the car, you know, with a stumble. Something fairly, relatively innocuous can lead to a meniscal tear and I certainly see that in my practice quite frequently in that middle-aged individual."[8]
- [48]Dr Ganko continued:
"He had some earlier degeneration, early arthritis in his knee and that may have related to his body weight, but the meniscus tear was most likely in my opinion a discrete tear which it would have occurred at a point in time and would have occurred probably at the time in January seemingly about two weeks before his – he saw his GP when he developed knee pain."[9]
- [49]The Appellant questioned Dr Ganko as to Mr Williams' comments to Dr Brosnan that all he had experienced with his knee was tenderness which was largely resolved by the use of analgesics. Dr Ganko's response was that the General Practitioners' records would deny that proposition. Dr Ganko said the continued presence of Mr Williams at the General Practitioners' practice between January and March 2014 showed that he had on going symptoms with his knee and that would be common with that type of meniscus tear.
- [50]Concerning the first MRI, Dr Ganko made contact with the Radiologist, Dr Hooper, as he thought that Dr Hooper had missed the significant tear as it was a flap tear that causes the oedema of the medial ligament and that caused the pain that was ongoing. Consequently that report was amended.
- [51]Dr Ganko stated that the meniscus was already torn and extruded from the joint causing the pre-existing symptoms. In his view, this made the meniscus extremely vulnerable to even minor or no trauma to tear further. He said that something must have happened to Mr Williams around 2 April 2014 that caused further inflammation in his knee and probably extended the tear in the meniscus.
- [52]The Appellant submitted that, in considering the evidence of the Medical Specialists, Dr Brosnan, like WorkCover was given a false history of no prior knee problems by Mr Williams.
- [53]The common ground between the Medical Specialists was that the MRI investigations on 19 March 2014 and 2 April 2014 reveal that the second MRI contained worse findings for Mr Williams. Also agreed was the findings in the second MRI are potentially consistent with the alleged mechanism of injury as given by Mr Williams.
- [54]The Appellant's position, however, was that Mr Williams' self-report required consideration. In its view, if that self-report was brought into serious question, then so too would be any medical report that was reliant upon that self-report.
Consideration of Mr Williams' Credit and Reliability
- [55]The Appellant referred to the evidence given by Mr Williams as it related to:
- (a)Mr Williams' representation of fact to Mr Christie on 27 March 2014 that Mr Brady was a witness to the incident in which he allegedly injured himself;
- (b)a Workers' Compensation representative on 28 March 2014 when asked if he had any pre-existing injury/s to which he replied "In his teens he cut his left knee on a piece of corrugated iron" (has a scar); but then provided no further insight into his more recent complaints to his GP in respect of his left knee pain;
- (c)the first consultation with Dr Brosnan on 2 April, 2014 during which Mr Williams would have been asked about any previous knee injury and nothing was revealed;
- (d)the revelation of the existence of the earlier MRI of 19 March 2014 by the time of the next appointment with Dr Brosnan on 3 April 2014, as identified in the MRI report of 2 April 2014. In response to further questioning from Dr Brosnan, it was recorded "Brian today did add that he did in fact see his LMO approximately one month ago with some tenderness around his knee which settled with simple analgesia."
- [56]To elaborate on these points, the Appellant considered Mr Williams' responses to how he had injured his knee. He had agreed that there was no "twisting" of his knee. However, he said he could not recall if he had told Mr Christie to record "twisting" in the Incident Report. The Redcliffe Hospital Report recorded Mr Williams' use of the word "twisted" in its records, but Mr Williams did not recall saying that.
- [57]The Respondent responded by saying that Mr Williams' evidence was that he had not mentioned "twisting" but that term was made by Mr Christie and the staff at the Redcliffe Hospital.
- [58]When Mr Williams was questioned during the proceedings about his failure to disclose the fact that he had prior knee symptoms to medical personnel and investigators, he responded with "no comment" on a number of occasions. The Respondent says that while this failure to disclose is not an "ideal response from a witness", the question of "injury" and "wear and tear" had been the subject of examination in chief and cross examination during Mr Williams' evidence and Mr Williams believed that the problems with his knee related to wear and tear. As well, the Respondent says that there was "no evidence adduced that Mr William had ever been asked whether he had had any investigations, MRI scans or have been taking any medications or had any previous knee pain which he related to work duties."
- [59]The Appellant said that Mr Williams associated the onset of his problems with his knee to "work duties" and that this was a false claim. The Appellant said that the claim relating to "work duties" was evidenced by Mr Williams when cross-examined. That evidence showed when the initial period within which he noted his pain and symptoms arose was around the same time he had been on annual leave. That pain and his initial recollection was recorded in his General Practitioner's notes. The Appellant also referred to Mr Williams' evidence relating to the matter of witnesses to his incident. Mr Brady had denied seeing any incident.
- [60]The Appellant says that the most important statements made by Mr Williams concerned his evidence relating to any prior incidents with his knee. Mr Williams had recalled an event when he was young where he had lacerated his knee, but made no mentioned of his consultation with Dr Woollons just a few days prior to making his claim. The history provided to Dr Brosnan was that he had prior tenderness in his knee but he revealed this only after the MRI had been discovered. Dr Ganko was clear when he said that "GP records would deny that". Dr Ganko further stated "He presented recurrently to the GP, you know, between January and the time of this scan on the – the 19th of March, he had ongoing symptoms related to that knee and that would be common with that type of meniscus tear."[10]
- [61]The Appellant said that a "fair consideration" of the evidence would show that Mr Williams had told deliberate untruths to WorkCover and to Dr Brosnan. This would seriously affect his credibility, in its view.
Consideration of the Evidence and Submissions
- [62]The Appellant's submission was that when the expert medical and factual evidence is considered, the Commission could not safely determine that Mr Williams suffered a workplace injury. Primarily, the credit and reliability of Mr William's evidence was critical to the case.
- [63]It is submitted by the Appellant that, at the time of the alleged injury, Mr Williams had prior experience and knowledge of the workers' compensation system in that he was aware that acceptance of the claim would allow the reimbursement of lost wages and the costs of medical treatment. Such reimbursement would also be met in terms of any surgery which may be required.
- [64]The Appellant detailed the history of Mr William's knee problems prior to 27 March 2014.
- On 24 January 2014, at a visit to his General Practitioner, it was noted that the reason for Mr William's visit was that the pain in his left knee was getting worse. X-rays of both knees were ordered.
- On 4 February 2014, Mr Williams again visited his General Practitioner for a follow-up visit relating to his knee where it was stated that "effusion noted more on the right than the left – continue exercise for the knee."
- On 7 March 2014, Mr Williams again contacted his General Practitioner for problems with his left knee. The notes state: "Still problem with the left knee - comes back when he stops the Voltaren … and also taking Panadol Osteo." The General Practitioner discussed with Mr Williams "knee management".
- On 12 March 2014, Mr Williams contacted his General Practitioner where it was determined that diagnostic imaging was required and an MRI of the left knee ensued on 19 March 2014.
- On 25 March 2014, the MRI findings were discussed with Mr Williams by his General Practitioner and he had considered referring Mr Williams to an Orthopaedic Specialist for "…significant symptoms".
- Dr Cruz had also referred to "knee management" and a referral to a specialist. Mr Williams' knee problems had been ongoing during this period so much so that investigative processes were required (X-rays after 24 January 2014 and an MRI on 19 March 2014).
- [65]In its attempt to ascertain the nature of Mr Williams' knee symptoms prior to 27 March 2014, the Appellant called evidence from Dr Ganko (Orthopaedic Specialist) whose particular area of expertise was knee orthopaedics. Dr Ganko's evidence is found in paragraph 46 of this decision. (Michelle – change para number once formatting complete).
- [66]Primarily, that evidence was that the type of meniscus tear experienced by Mr Williams caused on-going symptoms. It does not necessarily disable one in that walking is impossible, but it does cause on going symptoms when a load is put on one's knee and these symptoms increase if there is twisting and turning.
- [67]Dr Ganko's evidence was that the MRI conducted on 19 March 2014 was abnormal. So much so, that Dr Ganko contacted Dr Tim Hooper, the reporting Radiologist, to discuss the issue. Dr Ganko opined that there was a significant medial meniscal tear at that time.
- [68]The Appellant said further consideration should be given to Mr Williams' prospective weight loss surgery and that he had in its view no health insurance. During the proceedings Mr Williams acknowledge this particular surgery would cost in the vicinity of some $10000 and he would most likely need to access his superannuation to pay for the surgery.
- [69]Dr Brosnan (Orthopaedic Specialist) also gave evidence concerning Mr Williams' knee condition. In response to Dr Ganko's opinion that there was a "significant medial meniscal tear", Dr Brosnan's opinion was that he would not have labeled the tear as "significant".
- [70]In response to the proposition put to him by Counsel for the Appellant: "That as I've called it, significant medial meniscal tear, together with this man's body weight, put him at risk - of great of further injury to the left knee, in regard to any - or any sorts of activities of daily living. What do you say to that" - Dr Brosnan - "I'd agree with that".
- [71]The Appellant reiterated the opinions expressed by Dr Ganko which state:
"He had a pre-existing medial meniscus tear. He was morbidly obese. I believe it likely that the meniscus would fail further within normal activities of daily living given that he had this significant pre-existing condition. The meniscus was already significantly torn and extruded from the joint causing the pre‑existing symptoms."
"It was already extruded from the joint to a degree and it was extremely vulnerable to - to, you know, even minor or no trauma to fail further, and certainly - I'm not sure it happened to him since then, but something happened around 2nd April that caused further inflammation to his knee and probably extended the tear to the meniscus."[11]
- [72]The Appellant considered that Dr Brosnan may have been "a captive to the false history" given by Mr Williams in the consultations on 2 and 4 April 2014.
- [73]The Respondent says that the alleged "false history" given by Mr Williams to Dr Brosnan is not defined and it was not open to the Commission to draw this conclusion.
- [74]There is no dispute between both specialists that when one compared the MRI of 19 March 2014 with that of 2 April 2014, the findings in the later MRI showed that Mr Williams' knee was in a worse condition.
- [75]The Respondent's submissions concerning the medical evidence is that "the medical evidence in this hearing varies only in the degree of the pathology that was caused on 27 March 2014. The difference between the opinion of Drs Ganko and Brosnan is largely an academic exercise in the finer points of interpretation of MRI scans of the knee."
- [76]The Respondent did not accept that Mr Williams had failed to report his knee history accurately to Dr Brosnan. In its view, the evidence provided was that Mr Williams had never been asked if he had any 'previous difficulties' or 'pre-existing conditions. on his left knee. The only evidence available on this point was Dr Brosnan's response to the following question: "And you being the competent orthopaedic surgeon that you are, as with any medical practitioner, you would have asked him on the 2nd as to whether or not he had any previous left knee problems, wouldn't you?" Dr Brosnan "I - well - yes, normally I would ask that question."[12]
- [77]While Dr Ganko said that the results of the second scan (2 April 2014) showed the amount of fluid in Mr William's knee and the inflammation around the medial collateral ligament had increased in comparison with the scan performed on 19 March 2014 indicating an acute injury around the time of the second scan. Dr Brosnan was the treating orthopaedic specialist who had the advantage of examining Mr Williams' knee within a week of the accident. He inspected the knee during the course of arthroscopic surgery on 29 July 2014.
- [78]The Appellant, when questioning Mr William's credibility, referred to what it perceived to be anomalies in his evidence. These are identified hereunder:
- Mr Williams advising Mr Christie on 27 March 2014 that Mr Brady was a witness to the incident where he said he had injured himself.
- Mr Williams advising the Workers' Compensation representative on 28 March 2014, upon being asked if he had any pre-existing injuries, replied "In his teens he cut his left knee on a piece of corrugated iron (has a scar).".
- During his first consultation with Dr Brosnan on 2 April 2014 where he had declared nothing about any previous knee injury.
"By the time of the next appointment with Brosnan on 3 April, the MRI report of 2 April 2014 revealed the existence of the earlier MRI of 19 March 2014. In response to further questioning from Dr Brosnan, it was recorded, "Brian today did add that he did in fact see his LMO approximately one month ago with some tenderness around his knee which settled with simple analgesia."
- Mr Williams said he had never referred to "twisting" his knee, however, Mr Christie and the records of the Redcliffe Hospital attribute the word "twisted" to Mr Williams' description of what had occurred to him.
- When questioned around the matter of "twisting" of Mr Williams' knee, Dr Brosnan responded:
Respondent - "In your experience as an orthopaedic surgeon, is the mechanism of injury as described, as in putting a left foot up on the side of the trailer and pulling - Mr Williams pulling himself up, pushing off with the right foot and pulling himself up on the trailer, is that consistent with this type of injury?"
Dr Brosnan - "Absolutely can be, particularly with his weight and the fact that when you're pushing up, you don't necessarily push up directly straight. People twist their knees whilst pushing as well. So I don't have any problem declaring the mechanism of his injury as consistent with that, yeah."
Respondent - "Okay. So, I'm sorry, why do you say there would be
twisting?"
Dr Brosnan "Sorry?"
Respondent - "Why are you saying there would be twisting? If he had twisted - all I'm saying people can twist their knees whilst going up onto the trailer. They don't necessarily just drive up straight. You know what I'm saying, is with weight and everything else, as you're moving up, you don't necessarily throw yourself directly straight, and this sort of injury, with him, would possibly be consistent with a twisting, as well as pushing up at the same time."[13]
- [79]Mr Williams, had during the course of his evidence, replied "no comment" to some questions posed by the Appellant. The questions related to querying why Mr Williams had failed to refer to his prior knee problems with his Doctors.
- [80]The Respondent says that while this response from Mr Williams was not an "ideal response from a witness", this was done against a background of Mr Williams having been asked on many occasions about the difference between his claim of 'wear and tear' on his knees and an 'injury' to his knees.
- [81]Mr Williams' evidence on whether or not he had told Mr Christie if there had been any witnesses to his alleged incident was clear "Well, Rob Christie asked if there was any witnesses and I said definitely no, because I'd just left". . However, the Appellant pointed out that during Mr Christie's evidence it was never put to him, in cross-examination, that Mr Williams would provide that evidence. It is noted that the Respondent did not follow up the Appellant's request to recall Mr Christie so that the evidence could be put to him for comment.
- [82]The Appellant questioned Mr Williams' claims that his knee problems were associated with the work he was performing with the Appellant. This claim required consideration against Mr Williams' other evidence that he often felt knee pain when waking in the morning and often after "unloading car boats."
- [83]The Respondent submitted that the recording of the event as described by Mr Williams - i.e. that there was no "twisting" involved in the incident - must be considered against the fact that when Mr Christie recorded the incident and used the word "twisting", what he had written was not shown to Mr Williams and after writing down what he had heard, Mr Christie shredded the paper.
- [84]As well, the Redcliffe Hospital records that:
"Stevedore - adjusting lashing - ½ metre step up L foot up on trailer and pulling self up and felt left knee POP go sideways and gave way".
"He was stepping up with his left knee half a metre onto a trailer to adjust a lashing and he heard a POP medial side of the knee which was painful and the L knee collapsed; he was holding a rail at the time and was able to pull himself up by the arms".
- [85]The Respondent said the Redcliffe records were tendered by consent. Mr Williams was not given the opportunity to review what had been written at the Hospital and he denied using the word 'collapsed'.
- [86]Mr Williams' evidence did not alter in any substantial way from the recording of what he purportedly said, save for the reference to the words "twisting" and "collapsed." The Redcliffe Hospital Reports stated, under the heading of Triage Assessment, "Stepping up onto back of truck this am at work knee twisted felt POP now C/O pain medial aspect L (knee able to wb with pain, paracetemol …".
- [87]While there has been contested evidence as to whether or not Mr Williams reported any witnesses being present when the alleged injury occurred, the Respondent says that Mr Williams' evidence on this point was made to WorkCover on 28 March 2014 where he claimed there had been no witness to the event.
- [88]The Respondent contends that the commentary on the incident report from Mr Christie's evidence, was not put to Mr Williams in cross-examination. The report had not been seen by Mr Williams and he had no opportunity to determine if it was accurate.
- [89]Concerning his knee problems, Mr Williams claimed not to have sustained any injury to his knee in or around January 2014. There was also no evidence to that effect. Mainly Mr Williams' evidence was that he had suffered from 'wear and tear' on his knees.
- [90]Mr Williams had told WorkCover that when questioned about an MRI on his left knee (2 April 2014). Mr Williams maintained that it was wear and tear and that he had not injured himself. Mr Williams frequently responded to questions from the Appellant during the course of his evidence that he never sustained an injury from early 2014.
- [91]The Respondent stated that Mr Williams did have health insurance (contrary to what was recorded on the Redcliffe Hospital records). Whether or not Mr Williams had paid for an MRI or others costs previously, with or without health insurance, was not raised in evidence.
- [92]Dr Brosnan's records state that Mr Williams had seen his LMO one month prior to his visit complaining of some tenderness about his knee which he says settled with simple analgesia. The Respondent says that this is consistent with the evidence of Dr Cruz on 7 March 2014.
- [93]On 12 March 2014, Dr Cruz ordered an MRI because there had been no improvement in Mr Williams' knee. Other than for ordering the MRI, the Doctor's records show that Mr Williams was "obese - Morbid".
- [94]In relation to Mr Williams' reporting of his knee problems, the Respondent argues that his explanation of his knee problem and pain as being intermittent due to wear and tear and when exacerbated (e.g. by unloading car boats) had settled with analgesia.
- [95]Primarily, the submissions of the Respondent are that the Appellant has been unable to prove on the balance of probabilities that "Mr Williams did not sustain an acute injury to his left knee on 27 March 2014 and in fact, all of the factual and medical evidence supports that the injury did occur and in the manner reported immediately and consistently.
Conclusions
- [96]In this matter the Appellant must convince the Commission, on the balance of probabilities that Mr William's injury did not arise out of, or in the course of his employment with QUBE Ports; or was one to which his employment was not a significant contributing factor. To meet that test, the Appellant bears the evidential onus of placing evidence before the Commission which goes to that point and it also has the persuasive onus in that the evidence must persuade the Commission that Mr William's claim should not have been one for acceptance.
- [97]There is no contest between the parties that Mr Williams suffered a meniscus tear in his left knee. The Appellant contends the meniscus tear did not arise out of his employment and more than likely arose before the workplace incident reported by Mr Williams on 27 March 2014. Further, that Mr William's employment was not a significant contributing factor to the injury.
- [98]Whilst the medical evidence presented left no doubt Mr William's suffered an injury to his left knee, the Appellant must be able to persuade the Commission that it is more likely than not the pain and symptoms complained of did not arise out of or in the course of his employment on 27 March 2014 and that his work not a significant contributing factor to the injury..
- [99]
"…expert medical evidence is only of value where the facts upon which it is founded are provided by admissible evidence. The evidence from the two doctors about the Appellant's history of her injury is not evidence of the facts of that history but does assist in relation to the issue of whether or when she reported the alleged fall and attributed her symptoms to it."
- [100]With that in mind it is not sufficient to rely on a statement that something happened. The party alleging the "fact" must provide some direct or corroborative material that demonstrates the existence of a fact in issue.[16]
Arose out of or in the course of employment?
Whilst I'm satisfied Mr Williams experienced knee pain and there is no question he did report an injury which he alleges arose out of his employment, I am persuaded that the initial pain and symptoms he complained of, arose some time before 27 March 2014 for the following reasons:
- On 24 January 2014, at a visit to his General Practitioner, it was noted that the reason for Mr William's visit was that the pain in his left knee was getting worse. X-rays of both knees were ordered;
- Mr Williams reported the pain initially arose some two weeks prior to the appointment. Mr Williams was on annual leave during this period for approximately seven days;
- On 4 February 2014, Mr Williams again visited his General Practitioner for a follow-up visit relating to his knee. Likewise, on 7 March 2014, Mr Williams again contacted his General Practitioner for problems with his left knee;
- On 12 March 2014, Mr Williams contacted his General Practitioner where it was determined that diagnostic imaging was required and an MRI of the left knee was undertaken on 19 March 2014;
- On 25 March 2014, the MRI findings were discussed with Mr Williams by his General Practitioner and at this point he considered referring Mr Williams to an Orthopaedic Specialist for "…significant symptoms".
- Dr Cruz had also referred to "knee management" and a referral to a specialist. Mr Williams' knee problems had been ongoing during this period so much so that investigative processes were required (X-rays after 24 January 2014 and an MRI on 19 March 2014).
- [101]By late March 2014, but just prior to the reported incident of 27 March 2014, it is clear that the nature of Mr William's knee pain extended beyond just the simple wear and tear he referred to in his evidence to the Commission. I am also satisfied Mr Williams was aware of the deterioration in his left knee based on his discussions with his treating GP's immediately before 27 March 2014. The materials before the Commission support the position that he was cognisant of the very real prospect he would require further consultations and medical treatment from an orthopedic specialist in the immediate future which would undoubtedly come at some cost.
- [102]Dr Ganko's evidence in respect of the nature and cause of the meniscus tear was persuasive and compelling. The history of consultations between Mr Williams and his GP's in respect of his knee pain and symptoms very much align with the medical evidence of Dr Ganko, who was of the opinion that the type of meniscus tear experienced by Mr Williams caused on-going symptoms. For example, he noted that the nature of the tear did not necessarily disable one in that walking is impossible, but that it did cause on going symptoms when a load is put on one's knee and that these symptoms increased if there is twisting and turning. Significantly, even on the day of the alleged workplace incident, Mr William's continued to unlash the boat from the trailer and was able to walk after the alleged incident. He also managed to drive himself to hospital.
- [103]Dr Ganko's evidence was also quite firm in his views that the MRI conducted on 19 March 2014 was abnormal. So much so, that he contacted Dr Tim Hooper, the reporting Radiologist, to discuss the issue. Dr Ganko opined that there was a significant medial meniscal tear at that time which fell well before the 27 March 2014 incident or the subsequent MRI investigations in early April 2014.
- [104]It is also of considerable concern that Mr William's failed to provide his medical specialist and WorkCover with the correct history of his left knee pain and symptoms prior to the alleged 27 March 2014 incident but after he had lodged his claim. For example, Mr Williams advised the Workers' Compensation representative on 28 March 2014, upon being asked if he had any pre-existing injuries, that "In his teens he cut his left knee on a piece of corrugated iron (has a scar)," yet made no mention of his appointment with his GP in respect of his left knee pain and symptoms and their discussions about a specialist just days beforehand.
- [105]Likewise, in his first consultation with Dr Brosnan on 2 April 2014 Mr Williams failed to declare any previous difficulties with his left knee. By the time of his next appointment with Brosnan on 3 April, the MRI report of 2 April 2014 had revealed the existence of the earlier MRI of 19 March 2014. In response to further questioning from Dr Brosnan, Mr Williams acknowledged tenderness around his knee which settled with simple analgesia, but he went no further than this.
- [106]On balance, Mr William's account of events has not been accepted by me as entirely credible. Whilst it is accepted by the parties that he has sustained a person injury in the form of a meniscus tear of the left knee, I find that it does not constitute an "injury" for the purposes of the Act. Consequently, I have not accepted Mr William's incurred an injury at the workplace on 27 March 2014. I further accept the Appellant has satisfied its onus of proof and established the Mr Williams has not sustained an injury within the meaning of the Act. The standard of proof is on the balance of probabilities and this has been met by the Appellant.
- [107]Accordingly, I order:
- The Appeal is allowed;
- The decision of the Regulator dated 11 June 2014 is set aside;
- The claim is not one for acceptance;
- The Regulator is to pay the Appellant's costs of and incidental to the Appeal. In the event agreement cannot be reached between the parties with respect to costs, the Appellant has the liberty to apply.
Footnotes
[1] [2015] QIRC 053.
[2] Newberry v Suncorp Metway Insurance Ltd [2006] QCA 48.
[3] (2004) 177 QGIG 769.
[4] (C/2012/35) – Decision
[5] (1997) 156 QGIG 100.
[6] Transcript of proceedings, QUBE Ports Pty Ltd v Simon Blackwood (Workers' Compensation Regulator) (Queensland Industrial Relations Commission, WC/2014/203, 17 October 2014) 28-29 (B. J. Williams).
[7] Transcript of proceedings, QUBE Ports Pty Ltd v Simon Blackwood (Workers' Compensation Regulator) (Queensland Industrial Relations Commission, WC/2014/203, 16 October 2014) 32 (A.D. Ganko).
[8] Transcript of proceedings, QUBE Ports Pty Ltd v Simon Blackwood (Workers' Compensation Regulator) (Queensland Industrial Relations Commission, WC/2014/203, 16 October 2014) 31 (A.D. Ganko).
[9] Transcript of proceedings, QUBE Ports Pty Ltd v Simon Blackwood (Workers' Compensation Regulator) (Queensland Industrial Relations Commission, WC/2014/203, 16 October 2014) 31 (A.D. Ganko).
[10] Transcript of proceedings, QUBE Ports Pty Ltd v Simon Blackwood (Workers' Compensation Regulator) (Queensland Industrial Relations Commission, WC/2014/203, 16 October 2014) 32 (A.D. Ganko).
[11] Transcript of proceedings, QUBE Ports Pty Ltd v Simon Blackwood (Workers' Compensation Regulator) (Queensland Industrial Relations Commission, WC/2014/203, 16 October 2014) 35 (A.D. Ganko).
[12] Transcript of proceedings, QUBE Ports Pty Ltd v Simon Blackwood (Workers' Compensation Regulator) (Queensland Industrial Relations Commission, WC/2014/203, 17 October 2014) 70 (R. F. Brosnan).
[13] Transcript of proceedings, QUBE Ports Pty Ltd v Simon Blackwood (Workers' Compensation Regulator) (Queensland Industrial Relations Commission, WC/2014/203, 17 October 2014) 67 (R. F. Brosnan).
[14] Pollock v Wellington (1996) 15 WAR 1 at 3.
[15] Kudryavtseva v Blackwood [2015] QIRC 053 [10] citing Coombes v Q-Comp (2007) 185 QGIG 680, 681 (Hall P).
[16] Momcilovic v R (2011) 254 CLR 1.