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  4. Parks v Workers' Compensation Regulator - [2018] QIRC 147

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Parks v Workers' Compensation Regulator[2018] QIRC 147

Parks v Workers' Compensation Regulator[2018] QIRC 147

QUEENSLAND INDUSTRIAL RELATIONS COMMISSION

CITATION:

Parks v Workers' Compensation Regulator [2018] QIRC 147

PARTIES:

Parks, Norma

(Appellant)

v

Workers' Compensation Regulator

(Respondent)

CASE NO:

WC/2016/151

PROCEEDING:

Appeal against a decision of the Workers' Compensation Regulator

DELIVERED ON:

30 November 2018

HEARING DATES:

17, 18 and 19 April 2018

1 June 2018 (written submissions of Respondent)

12 July 2018 (written submissions of Appellant)

18 July 2018 (written submissions in reply of Respondent)

HEARD AT:

Brisbane

MEMBER:

Industrial Commissioner Knight

ORDERS:

  1. The appeal is dismissed in respect of the claim for both psychological or psychiatric disorders.
  2. The decision of the Respondent dated 28 June 2016 is affirmed.
  3. The Appellant is to pay the Respondent's costs of and incidental to this appeal.

CATCHWORDS:

WORKERS' COMPENSATION – APPEAL AGAINST DECISION – Whether the appellant's pain and/or adjustment disorder is secondary to an accepted physical injury – questions around multi-factorial causation – association with employment in contention – whether pain and disability arising from a workplace injury were the major significant contributing factor to the onset of appellant's pain and/or adjustment disorder – whether injury removed from s 32(1) by virtue of the operation of s 32(5).

CASES:

Workers' Compensation and Rehabilitation Act 2003, s 32(1), s 32(5)(c), s 550.

APPEARANCES:

Mr G Carter, Counsel, instructed by Kare Lawyers, for the Appellant.

Mr S Gray, Counsel, directly instructed by the Workers' Compensation Regulator, the Respondent.

Decision

  1. [1]
    Ms Norma Parks ("the Appellant") appeals a decision of the Workers' Compensation Regulator ("the Respondent") dated 28 June 2016, in which it confirmed an earlier decision of Teys Self Insurance ("the self-insurer") to reject Ms Parks' application for compensation under s 32 of the Workers Compensation and Rehabilitation Act 2003 ("the Act") in respect of a psychological injury claimed to have developed as a secondary injury subsequent to an accepted lower back injury. The appeal is made under s 550 of the Act. 

Witnesses

  1. [2]
    For the Appellant:
  • Ms Norma Parks, previously a carton meat assessor for Teys Australia Biloela Pty Ltd ("Teys")
  • Dr Matthew Keys, Specialist Intensivist, Pain Management
  • Dr Peter Rofe, Consultant Psychiatrist
  • Dr Colleen Hendry, Consultant Psychiatrist
  1. [3]
    For the Respondent:
  • Mr Jamie Chapman, HR Manager, Teys Australia
  • Mr Bruce Munro – Health and Safety Manager, Teys Australia
  • Dr Baker, Neurosurgeon
  • Dr Gomez, Orthopaedic Surgeon
  • Dr Chalk, Consultant Psychiatrist

History of Ms Parks' claim

  1. [4]
    Ms Parks was employed as a Carton Meat Assessor with Teys. Her role involved packing and inspecting large chunks of meat (primals) in boxes, which would then be sent overseas.
  1. [5]
    On 23 October 2014, Ms Parks lodged an application for compensation with the self-insurer for a lower back injury which was sustained on 14 October 2014. A claims officer for the self-insurer, Mr Russell Schott, wrote to Ms Parks on 24 October 2014 accepting the claim for compensation and characterising the nominated injury as an 'episode of a soft tissue injury' for the period 17 October to 7 November 2014.[1]
  1. [6]
    Ms Parks was subsequently cleared to participate in a return to work program by Dr Glen Gomez, an Orthopaedic Surgeon, from 22 November 2014, which included a number of restrictions around her capacity to lift, stand and sit.[2]
  1. [7]
    Dr Gomez examined Ms Parks again on 14 January 2015, later issuing a further workers' compensation certificate, which provided clearance for her to return to normal hours, lift weights of up to 5kg and continue to participate in a suitable return to work program at the workplace.[3]
  1. [8]
    The self-insurer ceased Ms Parks' entitlement to workers' compensation benefits for her physical injury from 27 February 2015, determining she no longer had an incapacity for work as a result of the prior lower back injury. The decision by Teys to cease Ms Parks' entitlement to benefits was communicated to her via written correspondence on 18 February 2015.[4]
  1. [9]
    The self-insurer's position, having considered the reports and other materials, was that Ms Parks' symptoms were not consistent with the existing pathology and that she no longer required any further medical treatment in relation to the physical injury she had sustained in the workplace on 14 October 2014.[5]
  1. [10]
    Significantly, Ms Parks did not seek a review of the decision by the self-insurer to cease her workers' compensation benefits in relation to the lower back injury of 14 October 2014.
  1. [11]
    On 27 February 2015, Ms Parks met with representatives of her employer and a union delegate where, according to representatives of Teys, the cessation of her workers' compensation claim for her physical injury (lower back) was discussed, along with the decision by Teys not to allow Ms Parks to return to her position, in circumstances where she was presenting at work with medical limitations which it believed could place her at unnecessary risk of injury.[6]
  1. [12]
    On the same day, Ms Parks provided her employer with a general medical certificate, prepared by Dr Zaman from the Biloela Medical Centre, advising she was unfit to work from 2 March 2015 until 15 April 2015.[7]
  1. [13]
    On 9 April 2015, Dr Dique, one of Ms Parks' general practitioners at the Biloela Medical Centre, issued a further general medical certificate confirming she was unfit from work from 13 April 2015 until 15 May 2015.[8]
  1. [14]
    On 18 May 2015, Dr Dique prepared another general medical certificate confirming Ms Parks "has a medical condition and has been unfit for work since April 16th this year. She cannot return to her usual duties position due to this medical condition."[9]
  1. [15]
    Ms Parks resigned from her employment with Teys on 21 May 2015.
  2. [16]
    Some six months later, on 9 October 2015, Dr Peter Rofe, Consultant Psychiatrist, issued a workers' compensation medical certificate diagnosing Ms Parks as having chronic pain/major depression.[10]
  1. [17]
    The self-insurer assessed Ms Parks' claim for workers' compensation based on the certificate provided by Dr Rofe, and rejected the claimed injury on 15 January 2016. Ms Parks applied for a review of that decision through the Regulator. By decision dated 28 June 2016, the Respondent's Review Unit confirmed the self-insurer's decision and determined the claim should be rejected.
  1. [18]
    It is against that decision Ms Parks currently appeals.

Legislation

  1. [19]
    During the proceedings, the Regulator conceded Ms Parks was a worker within the meaning of the Act and that she had suffered a personal injury. The Regulator did not accept Ms Parks' employment was the major significant contributing factor to her psychological or psychiatric injuries. 
  1. [20]
    As such, the appeal turns on whether Ms Parks' psychological or psychiatric injuries were caused by her initial physical injury, and questions as to whether the pain and other limitations arising from her initial physical injury was the major significant contributing factor in the development of her psychiatric or psychological condition(s).
  1. [21]
    The relevant parts of the legislation for the time period material to Ms Parks' claim for workers' compensation, are set out below:

32 Meaning of injury

  1. (1)
    An injury is personal injury arising out of, or in the course of, employment if—
  1. (a)
    for an injury other than a psychiatric or psychological disorder—the employment is a significant contributing factor to the injury; or
  1. (b)
    for a psychiatric or psychological disorder—the employment is the major significant contributing factor to the injury (my emphasis).

…

  1. (5)
    Despite subsections (1) and (3), injury does not include a psychiatric or psychological disorder arising out of, or in the course of, any of the following circumstances—
  1. (a)
    reasonable management action taken in a reasonable way by the employer in connection with the worker's employment;
  1. (b)
    the worker's expectation or perception of reasonable management action being taken against the worker;
  1. (c)
    action by the Regulator or an insurer in connection with the worker's application for compensation.

Examples of actions that may be reasonable management action taken in a reasonable way—

  • action taken to transfer, demote, discipline, redeploy, retrench or dismiss the worker
  • a decision not to award or provide promotion, reclassification or transfer of, or leave of absence or benefit in connection with, the worker's employment

Appeal Details

  1. [22]
    Mr Parks contends she suffered an injury within the meaning of s 32(1) of the Act. Her representatives argue the appeal should be upheld in circumstances where the evidence shows, on the balance of probabilities, that:
  1. (a)
    Ms Parks developed a pain disorder with associated depression:

i) upon acquiring the physical workplace injury; and

ii) as a direct result of the pain suffered because of the physical workplace injury;

  1. (b)
    Ms Parks developed an adjustment disorder:

i) upon acquiring the physical workplace injury;

ii) as a direct result of the impact the physical injury had on her enjoyment of life; and

  1. (c)
    Ms Parks developed an adjustment disorder:

i) as a direct result of Teys' management action; and

ii) the management action was not reasonable or was not undertaken in a reasonable way;

iii) the adjustment disorder did not arise out of, or in the course of, Ms Parks' expectation or perception of Teys' reasonable management action being taken against her; and

  1. (d)
    the adjustment disorder did not arise out of, or in the course of, action by the Regulator or the self-insurer or in connection with Ms Parks' application for compensation.[11]
  1. [23]
    Conversely, the Regulator maintains Ms Parks' appeal should be dismissed in circumstances where:
  1. (i)
    insofar as Ms Parks' psychiatric or psychological disorder is causally connected with the accepted physical injury, that injury is not the major significant contributing factor; and
  1. (ii)
    Ms Parks' injury is otherwise excluded by the reasonable management action provisions of the Act. 

Issued To Be Determined

  1. [24]
    The appeal to the Commission is conducted by way of a hearing de novo. The questions to be answered in the determination of the appeal include:
  1. (i)
    whether Ms Parks' psychological or psychiatric injury arose out of, or in the course of, her employment;
  1. (ii)
    whether Ms Parks' employment is the major significant contributing factor to the injury; and
  1. (iii)
    whether, pursuant to s 32(5) of the Act, Ms Parks' psychiatric or psychological disorder is excluded from the definition of injury within the Act in circumstances where it arose:
  1. (a)
    out of reasonable management action taken in a reasonable way by the employer in connection with the worker's employment; and/or  
  1. (b)
    as a result of Ms Parks' expectation or perception of reasonable management action being taken against her; and/or
  1. (c)
    due to action taken by the Regulator or an insurer in connection with Ms Parks' application for compensation.
  1. [25]
    Whether, and to what extent, Ms Parks' employment contributed to the development of the psychological injury involves an examination of Ms Parks' physical injury, the onset of associated pain and other adverse effects that arose between the day of the injury and 9 October 2015, when Dr Rofe prepared a workers' compensation medical certificate in respect of her injury. 
  1. [26]
    For employment to be the major significant contributing factor, the employment must be important or of consequence, and there should be a nexus between the employment and the (psychological) injury.
  1. [27]
    In a case where expert medical evidence is led, the facts upon which it has been based must be supported by admissible evidence before it can be of value.

Ms Parks' (accepted) lower back injury claim – circumstances and medical evidence

  1. [28]
    In correspondence dated 24 October 2014, the self-insurer advised Ms Parks it had accepted her claim for workers' compensation for "an episode of a soft tissue injury to the lower back",[12] after she slipped and fell at work, landing on her back.
  1. [29]
    In a MRI report dated 19 October 2014, the findings included:

The alignment of the lumbar spine is normal. Mild disc desiccation is evident at L4/5 with a small annular tear and disc bulge. Remainder of the disc space heights and the vertebral body heights appear normal. No spondylolisthesis or significant facet joint arthropathy. …bone marrow and cord signals appear normal. Prevertebral soft tissues are unremarkable.

… 

CONCLUSION

Mild disc bulge at L4/5 with a small annular tear. No significant central narrowing of neural compromise.

  1. [30]
    In addition to being treated by general practitioner(s) during the period while Ms Parks' lower back injury claim was on foot (i.e. 16 October 2014 until 27 February 2015), she was also referred to Dr Gomez and, later, a neurosurgeon, Dr John Baker.
  1. [31]
    Ms Parks told the Commission that one of her GPs from the Biloela Medical Centre, Dr Dique, prescribed pain medication including Ibuprofen, Brufen, Cymbalta, Paralink, Lyrica, Celebrex and Tramadol, yet she initially maintained the medication did not really assist in terms of her pain.[13]
  1. [32]
    She also recalled Dr Gomez prescribed Panadol forte, Endone and Diazapan.[14] Later, after further questioning, Ms Parks appeared to change her mind and was of the view that medication such as Endone, which she seemed to think was actually prescribed by Dr Dique, did make the pain go away.
  1. [33]
    In his evidence to the Commission, Dr Gomez noted that it would abnormal for him to prescribe endone or opiate medication to treat an injury such as Ms Parks', in circumstances where he held concerns about the non-organic lumbar spine pathology.
  1. [34]
    In a letter dated 18 November 2014 to Dr Richard Tan of the Biloela Medical Centre, Dr Gomez noted:

Norma has a normal lower limb neurological examination bilaterally…..MRI scan shows a mild disc bulge at the L4-5 level with a minor annular tear. There is certainly no neural element compromise.

Norma's symptoms are more likely the result of a musculoligamentous injury, and I have discussed this with her…asked her to continue with her physiotherapy program and will review in four weeks.[15]

  1. [35]
    Ms Parks confirmed Dr Gomez told her on a number of occasions that there was not anything seriously wrong with her back. She told the Commission she was unhappy with what he was telling her in circumstances where she was experiencing pain.
  1. [36]
    Dr Gomez issued a further workers' compensation certificate for Ms Parks on 18 November 2014, advising she would be fit to participate in a suitable duties program in the workplace after 22 November 2014 and setting out restrictions in respect of lifting, standing and walking.[16]
  1. [37]
    Ms Parks was unable to specifically recall when she returned to work on light duties, but thought it was in November 2014. She said that part of her duties involved cleaning protective clothing, sorting and mending gloves and washing mesh clothing.[17] She said that, at the time, she felt good about returning to work.[18]
  1. [38]
    Mr Chapman, the onsite Human Resources Manager, initially told the Commission that Ms Parks never really undertook light duties in the laundry, but later conceded he could not really remember if she was placing laundry into pigeon holes and that she may have been performing her light duties.[19]
  1. [39]
    Mr Bruce Munro, an onsite Health and Safety Manager, recalled Ms Parks performing light duties in the laundry.[20]
  1. [40]
    In response to questions about her mobility while she was on light duties, Ms Parks confirmed she was not able to walk normally. She explained she used a walking stick because her right hip was a bit wobbly and she could not stand for too long.[21]
  1. [41]
    In a report dated 21 November 2014, Dr Gomez advised the self-insurer that an MRI of Ms Parks' lumbosacral spine showed a very mild disc bulge at the L4-5 level with a small annular tear, noting the remaining segments were normal with no neural element compromise.[22]
  1. [42]
    In the same report, Dr Gomez again confirmed Ms Parks had sustained a musculoligamentous back strain which, in his opinion, should improve with conservative management consisting of physiotherapy, anti-inflammatories, simple analgesia and the passage of time.
  1. [43]
    In his oral evidence, Dr Gomez told the Commission the results of the MRI were age appropriate, of limited clinical significance and, by and large, generally degenerative in nature.[23]
  1. [44]
    Dr Gomez estimated it would be reasonable to deem Ms Parks' injury stable and stationary after three months of conservative management, confirming she was also fit to return to work on suitable duties.
  1. [45]
    He explained to the Commission that the majority of people he saw with an injury similar to Ms Parks' would see a significant improvement to the injury over a number of weeks, with the vast majority experiencing complete symptom resolution within four to six weeks.
  1. [46]
    Dr Gomez considered that three months was a more than reasonable timeframe within which recovery would take place, but that Ms Parks did not show any significant improvement from a subjective reporting point of view within this period of time.[24]
  1. [47]
    In a workers' compensation certificate completed on 18 November 2014, Dr Gomez set out weight restrictions or other limitations associated with Ms Parks' return to work program.[25]
  1. [48]
    In further correspondence to the self-insurer dated 17 December 2014, Dr Gomez confirmed he examined Ms Parks on both 2 December and again on 17 December 2014, noting:

Norma's symptoms are certainly out of proportion with her pathology and essentially her MRI scan is normal. I would have expected more significant symptomatic improvement in Norma…I have reinforced to her that her MRI scan is essentially normal, and that she has a mild to moderate soft tissue injury which should improve significantly with simple analgesia, physiotherapy and the passage of time.

I will be reviewing her on 14 January following shut-down. I have indicated to Norma that I would expect her symptoms to have largely resolved and would be keen to send her back to work on full duties.[26]

  1. [49]
    A subsequent letter from Dr Gomez to one of Ms Parks' GPs, Dr Richard Tan, dated 14 January 2015, noted:

Norma has been very slow to improve following her injury around 3 months ago…. does not have any radicular symptoms or neurology. Norma's MRI scan is essentially unremarkable…

I believe she has discussed getting a second opinion from John Baker with you and I think this would be a very reasonable idea.

There is also some question of Norma's compliance… she has not been attending physiotherapy …not been performing her McKenzie exercise plan. On history Norma denies having any exercises to do…We are in a difficult predicament as Norma has little to do in the way of hard radiological evidence of an organic cause, and appears to be non-compliant with her recommended treatment program.[27]

  1. [50]
    On the same day of the examination (14 January 2015), Dr Gomez issued a workers' compensation medical certificate,[28] extending Ms Parks' hours of work to full-time and increasing the maximum weight she could safely lift.
  1. [51]
    Ms Parks was also referred for an examination to Dr Baker in late January 2015.
  1. [52]
    In a letter to one of Ms Parks' GPs, Dr Dique, dated 11 February, Dr Baker confirmed he had examined Ms Parks on 4 February.[29] In the report, he noted Ms Parks complained of pain all over her lumbar spine which radiated to both hips, but mainly on the right side.
  1. [53]
    Dr Baker reported Ms Parks was slow to follow instructions during the examination. His view was there was no evidence of structural or neurological injury on examination or investigation, nor any need for surgical intervention. Dr Baker highlighted the importance of taking measures to ensure Ms Parks' opinion of having sustained a serious injury was not reinforced.
  2. [54]
    In the final paragraph of his correspondence to Dr Dique, the neurosurgeon confirmed he was preparing a report for the self-insurer in which he was going to suggest that consideration be given to a further assessment at a Spinal Unit, and/or that a further independent medical examination be undertaken.
  1. [55]
    In his report to the self-insurer dated 11 February 2015, Dr Baker noted:

On examination of the MRI performed on 29 October 2014, there is very little to see in her lumbar spine. Degenerative changes are very mild. There is good preservation of disc heights throughout the lumbar spine. There are no disc prolapses. There is no evidence of nerve root compression. There is minor prominence of the annulus at L4/5 which is of no significance. There is a radiological feature described as a small annular tear, however its clinical significance is somewhat controversial and in my opinion there is no significance.[30]

  1. [56]
    Dr Baker stated in his oral evidence to the Commission that the MRI findings reported an 'annular tear' incorrectly. Instead, he said the report should have referred to an 'annular fissure'. He explained that annular fissures develop without trauma and that they can be a sign of degenerative change in a disc or something that occurs as the discs get older.[31] Dr Baker was of the view the MRI findings were consistent with someone of Ms Parks' age.[32]
  1. [57]
    In respect of the nature of Ms Parks' injury, Dr Baker's opinion was also that she had suffered a strain injury to the lumbar spine. In response to a question from the self-insurer in respect of Ms Parks' incapacity for work and the duration of the incapacity, Dr Baker advised:

Ms Parks at present has an ongoing incapacity for work. By mid-February, it will be four months since the work injury. I would have expected improvement to have occurred and ongoing symptoms minimal. Unfortunately with Ms Parks she has ongoing incapacitating symptoms with evidence of abnormal illness behavior. By the middle of February and most certainly by the conclusion of February, I would be of the opinion that the work related injury is no longer contributing to the incapacity. (my emphasis)

  1. [58]
    In the same report,[33] Dr Baker expressed the view that Ms Parks did not require any further treatment in respect of the work-related lower back injury and that he concurred with Dr Gomez's opinion in relation to his prior assessment of Ms Parks' presentation.
  1. [59]
    In his oral evidence to the Commission, Dr Baker explained that his clinical examination of Ms Parks and the symptoms she was exhibiting were inconsistent with neurological symptoms.
  1. [60]
    In response to questions about his view that Ms Parks was exhibiting abnormal illness behaviours, Dr Baker explained Ms Parks took a long time to respond to any instruction during his examination and then performed any manoeuvre he requested very slowly.
  1. [61]
    Dr Baker was of the opinion that abnormal illness behaviour is not treatable, but that orthopaedic surgeons were well versed in observing and identifying the behaviour.[34]
  1. [62]
    By way of example, he noted that during his examination of Ms Parks, minimal spinal movement appeared to be causing pain out of proportion with what one would have expected where there were no objective findings. Under cross-examination, he noted that abnormal illness behavior could be interpreted as pain behaviours. He explained that:

…we all know it when we see it because it's not what we normally see in someone who has pain. It's a different type of behavior. And the thing about it the – these behaviours are well reproduced….

…

…it's behaviour that is reproduced across the spectrum in different patients.[35]

  1. [63]
    Although Dr Baker had previously indicated in separate, but almost identical, correspondence to Dr Dique that he would be making a suggestion to the self-insurer around consideration being given to Ms Parks being assessed by a spinal unit and/or having a further independent medical examination, it is the case that, in the end, he did not include either of these suggestions in his report to the self-insurer.[36] 
  1. [64]
    In his oral evidence, Dr Baker noted that sometimes spinal units are referred to as pain units. He considered that a pain management program involving physiotherapists and occupational therapists could deliver a more holistic approach that may have been useful in giving Ms Parks a better understanding of why she was experiencing pain.[37]
  1. [65]
    Dr Baker said he was hopeful that such an approach would be followed up or acted upon by Ms Parks' GP, but that when it came to the self-insurer and her lower back injury, there was no further active medical treatment required.[38]
  1. [66]
    Dr Gomez was not copied into Dr Baker's report to Dr Dique, but did receive a copy of a similar report Dr Baker had prepared for the self-insurer, which concluded  Ms Parks did not require any further treatment in respect of her work-related lower back injury.
  1. [67]
    Having been given an opportunity to read Dr Baker's correspondence to Dr Dique prior to giving his evidence, Dr Gomez told the Commission that the concept of referring Ms Parks to a spinal unit would not have even come up as a consideration for him in circumstances where:

I don’t think there's any benefit at all. I mean a spinal unit is a unit specifically for people who have got, you know anatomical structural spinal problems, which – which Norma doesn’t, and I don’t think there'd be any benefit at all in – in referring her to a spinal unit.[39]

  1. [68]
    Likewise, in response to questions as to whether Ms Parks would have benefited from being referred to a multi-disciplinary pain management unit, Dr Gomez was of the opinion she would have received limited benefit given the lack of organic signs associated with her condition.[40]
  1. [69]
    Under cross-examination, Dr Gomez was of the view that there was limited benefit in Ms Parks being referred for an independent medical examination in circumstances where a further opinion had been sought from Dr Baker, noting:

…so you can keep going around in circles how many independent medical examinations do you get before you – you're satisfied. So she's seen myself as the primary treating physician who's given an opinion. She's then seen Dr Baker as independent medical assessor who, in his report, has given the same opinion, so I see the benefit in getting a further opinion when you've got two concordant opinions from two physicians is limited.[41]

  1. [70]
    On 25 February 2015, Dr Gomez wrote to Dr Richard Tan from the Biloela Medical Centre highlighting Ms Parks' claims of limited symptomatic improvement in her lower back, but also noting Dr Baker's opinion that Ms Parks' soft tissue (lower back) injury should have resolved with four months of conservative management.[42]
  1. [71]
    In response to questions as to why Ms Parks was still exhibiting pain in the absence of any supporting pathology, Dr Gomez told the Commission that abnormal illness behavior was a concern in Ms Parks' case. 
  1. [72]
    In response to questions about abnormal illness behavior, Dr Gomez explained that, when it came to the lumbar spine, there existed a collection of "Waddell's signs" – which he said were a group of physical signs which can indicate non-organic back pathology. Insofar as these signs related to Ms Parks' symptoms, Dr Gomez said:

Norma displays a few of these and – I think it's consistent in Dr Baker's report as well. He performs what's called a – an axial load test, which is – which is positive. It …reproduces pain in her lumbar spine. That's – that's a positive Waddell's sign, as is a straight leg raise at 90 degree.

Normally, if you're sitting up at 90 degree and you've got a lumbar spine pathology, your straight leg raise should be less than that it you're lying supine. Now, if – if you think of it from – from a – an anatomical point of view, when you're lying flat, all of your nerve structures, you know, which, basically, run along the posterior aspect of your body, if you would draw a – a line down the middle of your body, they're on the – the back half, they're less stretched than if you're sitting up so you should be able to raise a leg straight without tensioning a nerve to a…higher degree if a patient's lying flat than if they are sitting up.

Now, Dr Baker describes an increase in the ability to straight leg raise with Norma sitting up versus standing, so that's another positive Waddell's sign, and the third one that Norma displays is what we call superficial tenderness, so – so tenderness, really when you're just touching the skin or subcutaneous tissue without too much pressure to – to elicit any tenderness from a – a significant underlying structure, so they're three positive Waddell signs that…Norma displays and – any they're published and – and validated signs of – of non-organic lumbar spine pathology.[43]

  1. [73]
    On 27 February 2015, Ms Parks' entitlement to compensation as a result of her lower back injury was formally brought to a conclusion.
  1. [74]
    According to the self-insurer, Ms Parks' entitlement to benefits came to an end in circumstances where it considered the medical evidence from Dr Gomez, Dr Baker and Ms Parks' physiotherapist collectively highlighted that her symptoms were not consistent with the pathology, and that no further medical treatment in relation to the work injury was required. Ms Parks did not seek a review of the decision.[44]

Stand-down and eventual resignation

  1. [75]
    On 27 February 2015, Ms Parks attended a meeting at her workplace with Mr Chapman, Mr Munro and a union representative, Mr Michael Ainsworth.
  1. [76]
    Ms Parks confirmed in cross-examination that by this point Dr Gomez had issued a certificate essentially clearing her to return to her normal role in circumstances where he was of the view she was no longer suffering a work injury.[45]
  1. [77]
    According to a file note prepared by Mr Chapman at the time of the meeting,[46] the group spoke about the finalisation of Ms Parks' workers' compensation claim. In the same meeting the discussions then moved onto concerns of the employer that, notwithstanding certification confirming that Ms Parks was fit to return to employment, she was exhibiting signs of being unable to walk unaided. 
  1. [78]
    Mr Chapman's oral evidence was that the group discussed concerns about Ms Parks presented to work unable to walk without a cane. Further, that in the absence of any other medical documentation to support any other injury or restriction, it was basically unsafe for Ms Parks to be at work in her condition.[47] 
  1. [79]
    Mr Chapman's evidence was that during the meeting, Ms Parks maintained she could not work her full hours or do her job.[48] In response to questions as to whether the option of part-time work was discussed with Ms Parks, he recalled informing Ms Parks that if she presented with a medical certificate which included restrictions which they could follow and place into a plan, then she would be allowed to work. He said the purpose of the certificate was to ensure she would not be placed in a role where she would injure herself.[49]  
  1. [80]
    Mr Chapman acknowledged he had not included a reference in his file note about discussions around Ms Parks being able to return to work if she presented a medical certificate with restrictions.[50]
  1. [81]
    Mr Munro recalled discussions with Ms Parks on 27 February 2015 where the cessation of her workers' compensation entitlements was confirmed.
  1. [82]
    He told the Commission that during the meeting:

So it was explained to her that under the duty of care, we weren’t able to put her back into her position because she was saying she couldn’t do it…

…and that she would be stood down so that she could seek further attention or medical attention or advice as to where she was to go from there, and we would certainly be willing to have Norma back when she was fit to come back to work.[51]

  1. [83]
    Mr Munro was unable to recall any discussions in respect of Ms Parks return to work on a part-time basis or on light duties. He told the Commission they did not want to place her back into a role that was likely to injure her or aggravate her situation.[52]
  1. [84]
    In her evidence to the Commission, Ms Parks confirmed that at the time of the meeting with her employer she presented as being unable to walk without a walking stick.[53]
  1. [85]
    Ms Parks' recollection of the meeting was that Teys had expressed concerns about her having an accident at the workplace in circumstances where she was using a walking stick. After further questioning, she agreed that her understanding of the meeting was that Teys did not allow her back to the workplace because she was unable to perform her normal duties.[54] 
  1. [86]
    The note prepared by Mr Chapman on the day of the meeting contains a reference to the employer raising concerns about its duty of care to Ms Parks and its decision that she would not be able to return to the workplace given her mobility issues. It also included a reference to a question around income protection and the application process.
  1. [87]
    At some point during those discussions, it appears Ms Parks indicated she would speak to her solicitor and that she intended to see another GP in Gladstone who would refer her to another specialist.  Mr Chapman recalled Ms Parks indicating she was not happy with her current doctor.[55]
  1. [88]
    On the same day, Mr Parks obtained a general medical certificate from Dr Zaman at the Biloela Medical Centre which noted that she had a medical condition and would be unfit for work from 2 March 2015 until 15 April 2015.
  1. [89]
    In a letter dated 2 March 2015,[56] the employer took steps to confirm its understanding of the discussions which took place in the meeting with Ms Parks on 27 February 2015, noting: 

As an employer we have obligations under the Workplace Health and Safety Act 2011 (the Act) to provide a safe workplace, with the key principle of the Act being our 'duty of care'. This duty imposes an obligation on Teys to ensure the workplace health and safety of our employees in the workplace.

The primary obligation of an employer involves a responsibility not to place an employee in a position that is not practical for the employee to perform should they have certain medical limitations or restrictions, thus placing them at unnecessary risk of injury.

At this point in time you have stated to the company that it is not practical for you to perform your normal duties due to certain physical limitations or restrictions. As discussed at this point in time under our 'duty of care' the company has no other choice but to exclude you from the workplace until such time as you are able to perform your normal duties without restrictions.

  1. [90]
    Under cross-examination, Mr Chapman denied that the intent of the letter was to create the impression that Teys has an obligation under its 'duty of care' to exclude Ms Parks from the workplace, in circumstances where it was suggested no such duty existed.[57] Mr Chapman maintained that Teys did not want to allow someone who presented as being unable to walk unassisted, to be onsite and injure themselves.[58]
  1. [91]
    On the 9 April 2015, Ms Parks provided the employer with another general medical certificate which confirmed she was unfit for work from 13 April 2015 until 14 May 2015.
  1. [92]
    Finally, on 18 May 2015, Dr Dique issued a general medical certificate confirming Ms Parks had a medical condition and had been unfit for work since 16 April 2015, further noting that she was unable to return to her usual duties due to the medical condition. The certificates provided to Teys after 27 February 2015 did not include any specific comments or notes in respect of the nature of Ms Parks' medical condition, nor any reference to her undertaking some form of alternate suitable duties.
  1. [93]
    Ms Parks resigned her employment on 21 May 2015. Mr Chapman's evidence is that, prior to resigning, the union requested Ms Parks be paid her pro-rata long service leave. According to Mr Chapman, Teys confirmed it would pay Ms Parks her pro-rata long service leave at the time of her resignation.[59]

Medical evidence – nexus between physical injury and psychological injury(s)

  1. [94]
    The medical evidence in respect of Ms Parks' psychological or psychiatric condition(s) consisted of various medical reports and accompanying oral evidence. It is relevant that despite the physical injury being sustained in October 2014, there is no record of Ms Parks reporting any psychological symptoms to any of her treating medical practitioner until late April 2015, just after she had submitted her formal resignation.
  1. [95]
    Ms Parks told the Commission that at some point in December 2014 or January 2015, either Dr Dique or someone at the hospital suggested that she go and obtain some counselling through Anglicare. She told the Commission this was suggested to her because the people she was speaking to at the time considered she was suffering from depression.[60]
  1. [96]
    Ms Parks was unable to recall the specific date when she first received support from Anglicare, but thought that they might have called her in the second week of February 2015. Ms Parks said she attended some counselling sessions with Anglicare in March 2015.[61]
  1. [97]
    Significantly, for this matter, notwithstanding Ms Parks' evidence in respect of her engagement with Anglicare at some point between December 2014 and March 2015, no records in respect of any consultations or counselling sessions she may have attended at Anglicare during this period were provided to the Commission.
  1. [98]
    Further, during the proceedings, no medical records from either the hospital or the Biloela Medical Centre, where her general practitioner Dr Dique was based, were provided to the Commission.
  1. [99]
    Likewise, Dr Dique was not called to give evidence in relation to any symptoms of depression Ms Parks may have discussed with him from on or around December 2014 to March 2015 or at any point after this.
  1. [100]
    The absence of any records in relation to Ms Parks' reporting of depressive symptoms to her GP between the period she first sustained her physical injury (October 2014) until late April 2015, approximately two months after the cessation of her original WorkCover claim, is also consistent with a summary of Ms Parks' patient history from the Biloela Medical Centre, contained in the medicolegal report of Dr Colleen Hendry, Consultant Psychiatrist, where she notes the following:
  •  22/10/14: Presented with low back injury after fall at work.
  • From 22/10/14 – 24/04/15. No mention of any reported depressive symptoms to GP. No recommendation for psychologist or psychiatrist referral or start antidepressant medication.
  •  Endep started on 26/11/14 (reported for lumbar disc prolapse pain no note of depression;
  •  Consult with Dr Tony Dique on 16/02/15. Cymbalta 30mg OD started (no note of depressive symptoms. Note that Dr Baker reported "nothing wrong with her").
  •  Consult with Dr Tony Dique on 24/04/15 – referral letter to Dr Rofe (Psychiatrist). No mention as to why referred.
  • Consult with Dr Dique on 04/06/15 - Diagnosis Depression, increased Cymbalta to 60mg OD (my emphasis).[62]

Dr Rofe – Consultant Psychiatrist

  1. [101]
    Aside from the reference in Dr Hendry's report to a referral letter to Dr Rofe being prepared for Ms Parks by Dr Dique in late April 2015, the medical evidence before the Commission indicates the first time Ms Parks was formally diagnosed with depression was in late May or early June 2015, approximately seven months after her initial physical workplace injury. 
  1. [102]
    Dr Rofe's evidence to the Commission was that, at her initial examination, he considered Ms Parks was severely depressed and placed her on an antidepressant.[63] However, it is not clear on the evidence before the Commission whether Dr Rofe identified a link (if any) at this time between the onset of Ms Parks' depression and the physical injury she sustained at work in October 2014. 
  1. [103]
    It was not until 9 October 2015 that Dr Rofe issued a workers' compensation medical certificate with a diagnosis of "chronic pain/major depression." The stated date of injury noted on the workers' compensation medical certificate was recorded as 16 October 2014.[64]
  1. [104]
    In response to questions as to why he did not complete a workers' compensation form on Ms Parks' first visit in May 2015, Dr Rofe told the Commission:

I presume that the focus was on (indistinct) the initial consultations with her and it may have subsequently become clear to her and to myself that there was a potential claim there for the events that arose from her injury at King Brothers.[65]

  1. [105]
    Over the course of five consultations with Ms Parks from 25 May 2015 until 5 January 2016, Ms Parks provided Dr Rofe with an overview of the history and circumstances surrounding her physical injury, which included (my emphasis):
  • following her injury, she had a MRI which indicated a disc bulge (and an annular tear between L4 and L5 vertebrae);
  • that she had difficulty standing for any length of time;
  • that she is living with a partner;
  • that her partner has anger problems; he drinks beer to excess;
  • that her medication has included Endone (Opiate), Diazepam, Celerex and Lyrica;
  • that her specialist, Dr Gomez had told her she had a soft tissue injury and that there was nothing wrong with her; she was prescribed Endone and Diazepam by Dr Gomez;
  • Dr Gomez had given her a clearance to return to work and then HR had stood her down; she felt angry and isolated;
  • that the medical tribunal had assessed her case and said she was not impaired;
  • she described a burning pain in her right hip and right leg; and
  • she was getting panic attacks, with tightness in her chest and hot and cold flushes.
  1. [106]
    He further noted:

The fact that Orthopaedic Surgeons could find no organic pathology does not rule out the fact that she has developed a chronic pain syndrome. Indeed, I believe she showed pathology on MRI scans initially. I have not seen these scans. The description she gives is of a neuropathic pain syndrome and I feel to be fair she needs assessment by a chronic pain unit.

  1. [107]
    In a letter to Dr Dique dated 12 October 2015, Dr Rofe wrote:

I reviewed Norma on 9/10/2015. She remains in difficulties and is angry over her issues of claim. She asked if I would write out a new claim for a psychological injury on the basis of chronic pain and depression. I think there is a clear causal linked between her mood state and chronic pain and the injury. I have filled out a Workcover claim form and she will process this in the usual channels.

It may be accepted or not, but I feel that it is important to do this as whatever the reason, she is impaired and the fact that the orthopaedic opinion cannot find an easy cause for her pain, does not necessarily mean that a chronic pain syndrome has not developed. I have asked her to cease her Cymbalta and to substitute that with Lexapro and she continues with the low dose Endep 10mg as well as Lyrica and Tramadol. I will keep you informed of further contact (my emphasis).[66]

  1. [108]
    Dr Rofe was of the view Ms Parks was reactively depressed from the injury, the subsequent treatment, the chain of events and the loss of her job. He was of the understanding she was on light duties when she had been dismissed.[67]
  1. [109]
    Based on the history provided to him by Ms Parks, whereby it was Mr Rofe's understanding there were no psychological issues (other than a short period at the time of her marriage break-down) prior to her current depressive episode, he was of the opinion there seemed to be a clear temporal or timewise relationship between the injury, onset of her pain condition and subsequent depression.[68]
  1. [110]
    In further correspondence to Dr Dique on 27 October 2015, Dr Rofe wrote:

I reviewed Norma on 23 October 2015. I have re-prescribed Lyrica 75mg twice a day and asked her to remain on Lexapro. She has few options it seems with her WorkCover and I think the issue will be supporting her with her chronic pain condition. I do not feel she is malingering and she described some neuropathic pain in her right thigh.[69]

  1. [111]
    In a report to the self-insurer on 8 February 2016,[70] Dr Rofe noted he was unable to find any significant non-work related factors contributing to her current diagnosis and that the workplace injury had precipitated a depressive illness as well as a chronic pain syndrome.
  1. [112]
    He told the Commission that this sort of depression is a normal human reaction to loss and is referred to (in terms of psychiatric terminology) as an adjustment disorder with depressed mood. He was satisfied there were elements of this disorder present in Ms Parks, along with biological clinical depression.[71]
  1. [113]
    Dr Rofe opined Ms Parks' work-related injury precipitated her depression as well as her pain syndrome in circumstances where had had concluded Ms Parks was depressed due to developing a pain condition following her lower back injury at work.[72]
  1. [114]
    He was of the view that a diagnosis of pain-syndrome fitted the history in circumstances where Ms Parks was well before the injury at work and that her pain was caused by the fall at work, and then there seemed to be diagnostic evidence on MRI scans that she had damaged her back.[73] 
  1. [115]
    Dr Rofe clarified that, in psychiatry, one does not examine the patient. In those circumstances he was of the opinion Ms Parks should see an expert physician to physically examine her and undertake more investigations.[74]

Dr Chalk – Consultant Psychiatrist

  1. [116]
    The self-insurer also took steps to arrange an independent medical examination of Ms Parks, which was undertaken by Dr Chalk, Consultant Psychiatrist, on 16 December 2015.
  1. [117]
    Ms Parks provided Dr Chalk with an overview of the history and circumstances surrounding her physical injury,[75] which included (my emphasis):
  • that she slipped at work while transferring a carton of meat;
  • that she was cleared to return to full duties in February 2015, but could not do this and was then stood down;
  • that she continued to experience pain in her lower back, right hip and right leg;
  • that she saw Anglicare after her work had been terminated in March 2015;
  • that she had actually seen Anglicare three weeks before being stood down;
  • that she is very angry the doctors did not listen to her and they are saying there is nothing wrong with her; and
  • that she does not understand how doctors had come to this conclusion and she has sought psychological assistance.
  1. [118]
    Under the 'Summary and Assessment' heading of his report, Dr Chalk noted:

Her psychological symptoms would appear to have developed in the aftermath of the decision to essentially stand her down. She does not report the development of significant emotional difficulties prior to that, and this lady would appear to have remained pain focused. She believes she has been treated unjustly by a number of different specialists over time. She regards them as unsympathetic, in the pay of the company, and her emotional difficulties have arisen as a consequence then of the implications of the stand down which would appear to have crystalized her thoughts and emotions.

…

I think that this lady has developed symptoms of an adjustment disorder with depressed mood and this has, in my view, arisen as a consequence of the decision to effectively cease her employment in February.

I do not think that this lady is likely to benefit from any form of psychiatric or psychological treatment, and her ongoing level of anger is in my view, only likely to be assuaged through some legal outcome.[76]

Dr Matthew Keys, Pain Management Consultant

  1. [119]
    Approximately ten months later, Dr Matthew Keys, Pain Management Consultant, examined Ms Parks.
  1. [120]
    In a report dated 14 October 2016, Dr Keys noted the following under the heading 'Diagnosis of all work-related conditions':

Severe functional impairment and disability associated with chronic pain. The chronic pain is in the form of axial lower back pain which has a number of potential pain generators including the facet joints, the discs (this is supported by MRI evidence of an L4/5 annular tear) and the bilateral sacroiliac joints. Other issues include symptoms and signs consistent with fibromyalgia, plantar fasciitis, greater trochanter bursistis, left shoulder adhesive capsulitis, and depression associated with her loss of status, income and health.[77]

  1. [121]
    As to whether Ms Parks' 'work-related' condition is an aggravation of any pre-existing condition, Dr Keys was of the opinion the 'slip and fall' was associated with a likely worsening of prior discogenic pain, but also an initiation of new facetogenic pain, sacroiliac joint pain, and greater trochanter pain. He was of the view that Ms Parks had also experienced a significant decline in psychosocial health since the fall.[78]  
  2. [122]
    Under cross-examination and in response to questions about the source of facetogenic pain, Dr Keys explained the pain could be as a result of degeneration in the facet joints. According to Dr Keys, other causes of the pain could include infection or a strain of the capsule which surrounds the joint.[79]
  1. [123]
    In his oral evidence, Dr Keys expressed the view that the injury sustained by Ms Parks on 15 October 2014 was the cause of her worsening pain and current symptoms, however he also noted that other factors could be contributing to the pain, including fibromyalgia, plantar fasciitis, greater trochanter bursitis and adhesive capsulitis.[80]
  1. [124]
    In his report dated 14 October 2016,[81] Dr Keys was of the opinion Ms Parks would benefit from a series of diagnostic blocks to delineate where her pain was arising.
  1. [125]
    Although Dr Keys mentioned a number of potential pain generators in his report, noting Ms Parks was in the right age group and had imaging evidence of disc disease at L4-5 annular tear, he considered there may be other contributors as well.[82]
  1. [126]
    In relation to whether Ms Parks' annular tear was contributing to her back pain, Dr Keys was of the view he would need to see the results of the diagnostic injections in order to make that diagnosis.[83]

Dr Colleen Hendry, Consultant Psychiatrist

  1. [127]
    Approximately two and a half years after her initial lower back injury occurred, a further independent psychiatric medicolegal report was obtained on behalf of Ms Parks from Dr Hendry on 18 March 2017.[84]
  1. [128]
    Ms Parks provided Dr Hendry with some background in respect of her previous employment with Teys, the circumstances of her physical injury, her prior medical history and current symptoms which included (my emphasis):
  • that her injuries, as a result of the workplace accident on 16 October 2014, included a lumbar disc (L4-5) prolapse and a tear, which was apparent on an MRI;
  • that she was unable to work due to back pain from 16 October 2014 until 21 November 2014;
  • that she experienced ongoing pain issues, including not being able to sit for too long and an exacerbation of pain (especially in her heal) if she walked;
  • she refused to return to full duties and reported her employment was terminated on 27 February 2015;
  • she was quite angry about this and thought it was extremely unfair;
  • that she developed mood and anxiety symptoms around the time of the injury, but was not certain of the time when the symptoms first arose – this was because she was unaware at the time she was depressed because she had never been depressed;
  • that she would cry a lot around the time after the injury and rated her mood at the time at 0 out of 10;
  • that she experienced significant difficulties with her sleep and would have a total of four hours per night;
  • she reported her poor sleep was due to associated pain and discomfort; and
  • she reported poor concentration, low energy, anxiety symptom and that her appetite fluctuates.
  1. [129]
    In relation to significant stressors over the past few years, Dr Hendry noted that Ms Parks had reported that:
  • she had relationship issues with her partner and they nearly ended their relationship in or around June 2015;
  • she reported they had been arguing a lot and that he could not handle her being unwell; and
  • she reported moving out of their home for a few weeks and that the relationship started to improve towards the end of 2016.
  1. [130]
    In relation to her past psychiatric history, Dr Hendry noted Ms Parks had reported (my emphasis):
  • that her low mood around the time of her first marriage broke down was not depression, but a reaction that was quite normal for anyone given the circumstances;
  • that she had not taken any anti-depressant medication  prior to the workplace injury in 2014;
  • that she first saw her GP for depressive and anxiety symptoms shortly after her workplace injury in November 2014;
  • that she saw her GP because she was not sleeping very well and felt down and that he/she prescribed Endep / Cymbalta  in January 2015;
  • that she first saw a counsellor in February 2015;
  • that she was referred to Dr Rofe in February 2015, but had to wait until April 2015;
  • that she had a few panic attacks, but only in the context of stopping medication;
  • that she denied any past hospitalisations for mental illness; and
  • that she was particularly upset at the specialists reports from specialists paid by her employers.
  1. [131]
    Dr Hendry was of the opinion Ms Parks met the criteria for an adjustment disorder with mixed anxiety and depressed mood.
  1. [132]
    She also opined that it was more likely than not Ms Parks would also meet the criteria for a co-morbid pain disorder associated with both psychological factors and a general medical condition, chronic in nature, noting:

My opinion is based on her initial injury, that of a fall with imaging reporting L4-5 disc prolapse and annular tear (evident on MRI), having a role especially in the onset of Ms Parks' pain. It is my opinion that psychological factors have had a major role in the severity, exacerbation and maintenance of her pain. Evidence that supported this opinion was the documentation received of neurosurgical and orthopaedic opinions, including orthopaedic tribunal hearing reporting that there does not appear to be the presence of organic pathology that would explain severity, exacerbation or maintenance of the pain and her associated function impairment.

Also, that her severity and duration of symptoms is out of keeping with what would be medically expected for this type of injury. Other factors that helped form my opinion, was that a significant part of Ms Parks' ongoing functional impairment appears to be related to her fears of experiencing or exacerbating back pain, her ongoing anger and frustration at past employers and specialists, limited psychological insight, limited coping strategies and avoidance behavior. It is my opinion, that it is more likely than not that Ms Parks' Pain Disorder developed shortly after her workplace injury in October 2014 and that it has not resolved and she would currently satisfy the criteria. Both Pain Disorder Associated with Both Psychological Factors and a General Medical Condition and Adjustment Disorder with mixed Anxiety and Depressed mood have similar symptoms.

…..

It is my opinion that Ms Parks' psychological symptoms appeared to significantly worsen after February 2015 in relation to additional stressors of the termination of her employment, her anger and frustration at her perceived mistreatment by her past employer and various specialists, as well as significant relationship issues. These stressors were in my opinion the major contributing factors to her developing the Adjustment Disorder and given the pain itself was not the contributing factor to her worsening mood and anxiety symptoms, I believe it is important to identify and diagnose the two individual disorders.

  1. [133]
    Dr Hendry was of the opinion that Ms Parks' adjustment disorder with depressive and anxiety symptoms developed in or after February 2015, but was of the view that it was difficult to determine the exact moment of commencement due to Ms Parks' vagueness in respect of the exact dates she noticed depressive and anxiety symptoms and the nature of these early symptoms.
  1. [134]
    Further complicating the issue was that many of the mood and anxiety symptoms such as sleep interruption and changes in appetite, energy and concentration reported by Ms Parks could be attributed to a pain disorder, rather than an adjustment disorder.
  1. [135]
    In any event, Dr Hendry relied on the following reasons as to why she was of the view Ms Parks' adjustment disorder commenced in or after February 2015:
  • an absence in the General Practitioner notes of any depressive symptoms until June 2015;
  • an absence of a referral to a psychiatrist or psychologist until February 2015;
  • an absence of any notes by general practitioners attributing the prescribing of Endep and Cymbalta to treat depression, as opposed to pain;
  • an increase in Ms Parks' functioning (i.e. her return to light duties) from 21 November 2014 until her employment was terminated in February 2015;
  • significant stressors in February 2015, including her employer terminating her employment, anger and frustration at her employer and her perceived mistreatment; and
  • the likelihood she had significant relationship issues in circumstances where she reported her partner had anger issues and where they separated in June 2015.
  1. [136]
    Dr Hendry was of the opinion Ms Parks had developed some psychological symptoms from October 2014 to February 2015, which formed part of her pain disorder.
  1. [137]
    Notwithstanding the lack of certainty around the date of onset for Ms Parks' adjustment disorder, Dr Hendry was of the opinion that it was due to several contributing factors including:
  • reported pain and functional impairment from the workplace injury sustained in October 2014;
  • termination of her employment in February 2015; and
  • anger and frustration at perceived unjust treatment from her past employers and a number of specialist doctors that she believed have written unfavourable reports due to being paid by her employers.
  1. [138]
    Dr Hendry was also of the opinion that another significant contributing factor to Ms Parks' adjustment disorder was her ongoing relationship difficulties. For example, although she reported to Dr Hendry that her partner was mostly supportive, it was also the case that there were topics she was unable to discuss with him due to his anger, along with other difficulties, which resulted in a brief separation around June 2015.  
  2. [139]
    Dr Hendry also noted there was some variability in the severity of Ms Parks' depressive and anxiety symptoms, which, in her view, appeared to be related to Ms Parks' stressors (particularly her relationship issues, as her adjustment disorder symptoms appeared worst around June 2015, at the same time as her relationship separation) and her level of pain. Significantly, Ms Parks reported that her symptoms improved towards the end of 2016, which she believed was due to steroid injections reducing her pain.
  1. [140]
    According to Dr Hendry, Ms Parks reported that her relationship improved around this time as well and that, at the time of her examination, she was not on any antidepressant medication, with the exception of a low dose of amitriptyline.
  1. [141]
    Dr Hendry concluded her report with the following comments:

It is my opinion based on the severity of Ms Park's Adjustment Disorder symptoms and her Pain Disorder, and her associated deterioration and functioning that the workplace stressors are not solely responsible for the development of these disorders. It is my opinion that this reaction to her physical injury may be explained by some underlying personality traits that result in limited coping strategies at times of stress and make Ms Parks more predisposed to the development of an Adjustment Disorder at times of stress than an individual without personality vulnerabilities.

This is supported by her psychological issues around the time of her marriage breakdown. It is also supported by her degree of anger and suspicion at her perceived injustice at her past employer and various specialists seen. It is also supported by her lack of psychological insight regarding the role of her reaction, relationship issues and her view of her own personality on her current level of functioning.

Consideration  

  1. [142]
    In this matter, there are a number of discordant opinions from the expert medical witnesses in respect of Ms Parks' injury(s). These include the estimated timing and the onset of Ms Parks' adjustment disorder and/or pain disorder; the nature and source of Ms Parks' pain and/or whether, in fact, Ms Parks has developed a pain disorder; the nominated work and non-work stressors which may have contributed to her respective disorders; as well as the extent to which Ms Parks' work and/or non-work stressors may have contributed to the development of an adjustment disorder and/or the pain disorder.
  1. [143]
    To a lesser degree, there are also some variations in the reported history relied upon by the medical practitioners when arriving at their respective conclusions. 

Physical Injury

  1. [144]
    There is no question that on 14 October 2014 Ms Parks sustained a physical injury in the workplace when she slipped and fell onto her back. The injury was subsequently accepted by the self-insurer as an 'episode of a soft tissue injury'.
  1. [145]
    Dr Gomez diagnosed the injury as a musculoligamentous strain of the lower back, as did Dr Baker in February 2015.
  1. [146]
    By mid to late November 2014, it appears Ms Parks' was advised by Dr Gomez that she would gradually be returned to work on a suitable duties program and was subsequently provided with clearances in this regard.
  1. [147]
    It is not in contention that in her appointments with Dr Gomez, and from at least early December 2014, Ms Parks was advised by the specialist that her MRI scans were essentially normal and that her soft tissue injury should improve significantly with simple analgesia, physiotherapy and the passage of time.
  1. [148]
    It was around this period that Ms Parks requested, through her GP, that she be referred to another specialist, Dr Baker, for a second opinion.
  1. [149]
    In terms of a standard recovery period for such an injury, Dr Gomez estimated it would be reasonable to deem Ms Parks' injury stable and stationary after three months of conservative management. Dr Gomez told the Commission that the majority of people he saw with an injury similar to Ms Parks' would see a significant improvement to the injury over a number of weeks, with the vast majority experiencing complete symptom resolution within four to six weeks.
  1. [150]
    Likewise, Dr Baker, from whom Ms Parks sought a further opinion, was of the view that Ms Parks' injury should have improved and that he would have expected her ongoing symptoms to be minimal by mid-February 2015. Despite this, Ms Parks continued to report pain symptoms to Dr Gomez and, later, to Dr Baker.
  1. [151]
    In relation to Ms Parks' reporting of pain symptoms, both Dr Gomez and Dr Baker told the Commission they observed signs of abnormal illness behavior when examining Ms Parks. In addition, following their clinical examinations of Ms Parks, both Dr Gomez and Dr Baker were of the opinion the symptoms she was exhibiting were inconsistent with neurological symptoms. 
  1. [152]
    Eventually, Ms Parks' entitlement to workers' compensation benefits came to an end in circumstances where the self-insurer considered the medical evidence from Dr Gomez, Dr Baker and Ms Parks' physiotherapist collectively highlighted that her symptoms were not consistent with the pathology, and that no further medical treatment in relation to the work injury was required.
  1. [153]
    Importantly, Ms Parks did not seek a review of the decision to cease her entitlements insofar as they related to her physical injury.

Did Ms Parks' develop an adjustment disorder as a result of acquiring her physical injury?

  1. [154]
    Having considered the medical opinions before the Commission in relation to Ms Parks' illness, I am of the view that there is no question Ms Parks has developed an adjustment disorder.
  1. [155]
    In those circumstances, the principal determination to be made in respect of the evidence is what stressor or stressors led to the onset of her depression. While a number of factors have certainly contributed or possibly perpetuated Ms Parks' depression, this appeal turns on what is the major significant contributing factor to the onset of her adjustment disorder.
  1. [156]
    In this regard, representatives for Ms Parks maintain she developed an adjustment disorder upon acquiring her physical workplace injury and as a direct result of the impact the physical workplace injury had on her enjoyment of life; as well as a direct result of management action on the part of Teys which was not reasonable or was not undertaken in a reasonable way.
  1. [157]
    Conversely, the Respondent contends Ms Parks' employment, insofar as the physical injury is concerned, is not the major significant contributing factor, and that her injury is otherwise excluded by the reasonable management action provisions of the Act.
  1. [158]
    Ms Parks' evidence during the proceedings was that she recalled experiencing some psychological symptoms following her physical workplace injury between the periods of December 2014 to February 2015.
  1. [159]
    However, although she was able to provide more details about the depressive symptoms she maintains she experienced approximately two years after the event, she struggled in both in her evidence to the Commission and, it seems, in her discussions with various medical specialists, to identify or describe with any precision or certainty the timing of the onset of such symptoms. The situation is not helped by the lack of contemporaneous documentation such as medical notes of reported depressive symptoms or records of Ms Parks seeking assistance or counselling before she was stood down by her employer in late February 2014.   
  1. [160]
    For example, Ms Parks told the Commission she had taken steps to contact Anglicare in December 2014, following an observation (by Dr Dique or someone at the hospital) that she may have been depressed.
  1. [161]
    Although Ms Parks' comments in relation to seeking support from Anglicare are consistent with the history she reported to Dr Chalk, the Commission was not provided with any record of the counselling.  Further, while Dr Chalk noted Ms Parks reported to him that she had seen Anglicare three weeks prior to being stood down by her employer, his report suggests that her claims about seeing Anglicare before she was stood down were inconsistent with other materials she provided to Dr Chalk on the day of her examination. 
  1. [162]
    As such, having considered the materials before the Commission in relation to Ms Parks' medical history and symptoms, and in circumstances where Ms Parks own account of the onset and timing of her depressive symptoms to the Commission was somewhat vague and inconsistent with other reports which were provided during the hearing, I am satisfied the first clear indication or record that Ms Parks' may have been exhibiting psychological symptoms appeared in April 2015.
  1. [163]
    As best I understand it, at that time Ms Parks was referred to Dr Rofe (in late April 2015) by her treating general practitioner, Dr Dique. The reasons for Ms Parks' referral are not entirely clear in circumstances where Dr Dique did not give evidence during the hearing of the appeal and where the Commission was not provided with the original referral letter or medical notes relating to any consultations leading up to Ms Parks' referral to Dr Rofe.
  1. [164]
    Dr Rofe told the Commission that at her initial examination in May 2015 that he considered Ms Parks severely depressed and placed her on an antidepressant,[85] but there is no evidence before the Commission that Dr Rofe had identified, at that stage, a link between the onset of Ms Parks' depression and the physical injury she sustained in the workplace.
  1. [165]
    Certainly, it was not until 12 October 2017, twelve months after her original physical workplace injury, that Mr Rofe sent a brief note to Dr Dique advising Ms Parks "remains in difficulties and is angry over issues of her claim. She asked me if I would write out a new claim for psychological injury on the basis of chronic pain and depression".[86]
  1. [166]
    Ms Parks was subsequently referred to Dr Chalk for an examination. He determined that her symptoms – including anger, difficulty sleeping, poor focus and irritability – developed in the aftermath of Teys' decision to essentially stand her down when she advised she was unable to return to her duties.
  1. [167]
    Dr Chalk eventually concluded Ms Parks had developed symptoms of an adjustment disorder with depressed mood.
  1. [168]
    In her examination, Dr Chalk noted Ms Parks reported she had been treated unjustly by a number of different specialists over time and was of the opinion her emotional difficulties had arisen as a consequence of the stand-down in February 2015, which he noted "would have appeared to have crystalised her thoughts and emotions".
  1. [169]
    In his report, Dr Chalk recorded that Ms Parks did not note the development of any significant emotional difficulties prior to being stood down.
  1. [170]
    Although Dr Hendry was of the view that Ms Parks' adjustment disorder developed in or after February 2015, she highlighted the challenges associated with determining the exact commencement of the condition, in circumstances where Ms Parks had also been vague with her in regards to the initial dates that she first noticed depressive and anxiety symptoms and the nature of the early symptoms.
  1. [171]
    In her report, Dr Hendry recorded she was of the opinion Ms Parks' adjustment disorder was due to several contributing factors including ongoing reported pain and functional impairment from the workplace injury, termination of her employment in February 2015, anger and frustration at her perceived unjust treatment from her past employers and a number of specialist doctors, as well as her ongoing relationship difficulties.
  1. [172]
    Other reasons as to why Dr Hendry considered Ms Parks' adjustment disorder did not commence until on or after February 2015 included the lack of any documentation referring to depressive symptoms prior to this time, in addition to her ability to increase her functioning and return to work on light duties until she was stood down in February 2015. 
  1. [173]
    Dr Hendry was also of the opinion that Ms Parks was more predisposed to the development of an adjustment disorder at times of stress than an individual without personality disorders.
  1. [174]
    In support of this position, Dr Hendry pointed to Ms Parks' psychological issues around the times of her marriage breakdown, her degree of anger and suspicion and perceived injustice at her past employer (Teys) and various specialists attended upon, along with her lack of psychological insight regarding the role of her reaction, relationship issues and her view of her own personality on her current level of functioning.    
  1. [175]
    Having considered the medical opinions before the Commission in relation to the timing and stressors which led to the onset of Ms Parks' adjustment disorder, I prefer the medical evidence adduced by the Respondent.
  1. [176]
    That is, Ms Parks' adjustment disorder developed in the aftermath of the decision to essentially stand her down and as "a consequence of the decision to effectively cease her employment in February 2014".
  1. [177]
    Although Dr Hendry lists Ms Parks' ongoing pain and functional impairment from the original physical injury and relationship issues as a further contributing factor in respect of the development of her adjustment disorder, the preponderance of evidence supports a finding that the major significant contributing factor in the onset of Ms Parks' adjustment disorder was her employers' decision to stand her down, and the implications of the stand down.
  1. [178]
    Significantly, a common theme throughout the history reported by Ms Parks not only to Dr Chalk but also Dr Rofe around the time her (psychological) claim was lodged, and later Dr Hendry, was Ms Parks' belief that she had been treated unjustly by any number of different specialists as well as her employer over time, subsequently resulting in her being stood down.
  1. [179]
    In Dr Rofe's case, the first sentence in his brief note to Dr Dique on 12 October 2015, which ultimately set the ball rolling in terms of Ms Parks' WorkCover claim for a psychological injury, immediately refers to Ms Parks' anger in relation of her prior WorkCover claim.
  1. [180]
    A subsequent report prepared by Dr Rofe in February 2016 records Ms Park as feeling angry and isolated after being stood down.
  1. [181]
    Likewise, Ms Parks told Dr Hendry nearly two and a half years after her initial physical injury that she was quite angry about being stood down by her employer and that she was particularly upset at the specialist's reports, prepared by those who were paid by her employers at the time she lodged her claim for a physical injury.
  1. [182]
    In my view, there is no reliable evidence before the Commission that indicates Ms Parks had developed any depressive symptoms as a result of her physical injury before the period where she was stood down by her employer.
  1. [183]
    Further, all of the available evidence in respect of Mr Parks' physical injury is that it should have resolved before February 2015. Insofar as there was a link between Ms Parks' ongoing reported pain and the onset or perpetuation of her depressive state, I note that there was also no certainty provided from Dr Keys in respect of the source of Ms Parks' ongoing pain, to the extent that his own report suggested further investigations be undertaken.  
  1. [184]
    In those circumstances, I am satisfied that Ms Parks' adjustment disorder did arise out of her employment, but that the major significant stressor, insofar as it relates to her employment, was the eventual decision by her employer to stand her down when she was unable to return to her full duties, against a backdrop where Ms Parks eventually came to believe she had been treated unjustly by any number of different specialists as well as her employer.

Was it reasonable for Teys to stand down Ms Parks and was this process undertaken in a reasonable manner?

  1. [185]
    Notwithstanding the finding by the Commission that Ms Parks' employment is the major significant contributing factor in respect of her adjustment disorder, it is necessary to examine whether her disorder is removed or excluded from the definition of injury in accordance with s 32(5) of the Act.
  1. [186]
    Insofar as the exclusions at s 32(5) of the Act are relevant to this matter, the Regulator maintains Ms Parks' injury is otherwise excluded by the reasonable management action provisions of the Act.
  1. [187]
    Conversely, Ms Parks' representatives contend:
  1. (a)
    Ms Parks developed an adjustment disorder:

i) as a direct result of Teys' management action; and

ii) the management action was not reasonable or was not undertaken in a reasonable way;

iii) the adjustment disorder did not arise out of, or in the course of Ms Parks' expectation or perception of Teys' reasonable management action being taken against her; and

  1. (b)
    the adjustment disorder did not arise out of, or in the course of action by the Regulator or Teys Self Insurance or in connection with Ms Parks' application for compensation.[87]
  1. [188]
    I am satisfied there is a direct link between the development of Ms Parks' adjustment disorder and the actions taken by Teys' management to stand Ms Parks down from her position around the time her workers' compensation claim for a physical injury was concluded, and when she advised she was unable to resume her normal duties in late February 2015 due to her being unfit for work.
  1. [189]
    Ms Parks attended a meeting at her workplace with the HR Manager, the OH&S Manager and a union delegate on 27 February 2015.
  1. [190]
    At that meeting, Ms Parks presented as being unable to walk unaided, notwithstanding that both Dr Gomez, Dr Baker and Ms Parks' physiotherapist had previously advised the self-insurer that the pain and limitations being reported by Ms Parks were not consistent with the pathology and nature of her injury. Dr Gomez and Dr Baker had also confirmed Ms Parks did not require any further medical treatment in relation to her original workplace injury sustained on 14 October 2014.
  1. [191]
    On or around the same day as her meeting with representatives of her employer, Ms Parks also presented a new general medical certificate prepared by Dr Zaman from the Bileola Medical Centre confirming she was unfit for work from 2 March 2015 to 15 April 2015.
  1. [192]
    In circumstances where Ms Parks provided the employer with a medical certificate stating she was unfit to work and where she was presenting as being unable to walk without the support of a walking aid, I am satisfied it was reasonable for her employer to hold concerns in relation to Ms Parks' capacity to undertake her normal duties in a safe manner. 
  1. [193]
    I note that the certificate provided by Dr Zaman simply stated Ms Parks would be unfit for work from 2 March 2015 until 15 April 2015.  The certificate did not include any further comments or suggestions as to whether Ms Parks was able to undertake other suitable duties or to work in a part-time or reduced hours' arrangement.
  1. [194]
    In a letter dated 2 March 2015,[88] the employer took steps to confirm its understanding of the discussions which took place in the meeting with Ms Parks on 27 February 2015, noting: 

As an employer we have obligations under the Workplace Health and Safety Act 2011 (the Act) to provide a safe workplace, with the key principle of the Act being our 'duty of care'. This duty imposes an obligation on Teys to ensure the workplace health and safety of our employees in the workplace.

The primary obligation of an employer involves a responsibility not to place an employee in a position that is not practical for the employee to perform should they have certain medical limitations or restrictions, thus placing them at unnecessary risk of injury.

At this point in time you have stated to the company that it is not practical for you to perform your normal duties due to certain physical limitations or restrictions. As discussed at this point in time under our 'duty of care' the company has no other choice but to exclude you from the workplace until such time as you are able to perform your normal duties without restrictions.

  1. [195]
    The letter went on to advise Ms Parks to contact the employer with an update on her progress and any possible return to work.
  1. [196]
    In all of those circumstances, I find it entirely reasonable for Teys to have raised the concept of its duty of care with Ms Parks and highlight its responsibility not to place her in positions of unnecessary risk by insisting that she return to her full-time role.
  1. [197]
    Likewise, in the absence of a clearance from a medical practitioner that Ms Parks was able to undertake some form of alternative duties or part-time work, I find that it was reasonable and understandable that Teys did not take steps to identify another role or set of responsibilities that she may have been able to undertake.
  1. [198]
    I note that in the meeting on 27 November 2015 and for a period thereafter, it is clear Ms Parks was interacting with her union representative on various issues relating to her employment. Even if, for some reason, she was unable to articulate a suggestion around how she might return to work, it was open to Ms Parks to make a suggestion though her union representative in the event a clearance had been provided by a medical practitioner. 
  1. [199]
    In light of these circumstances, I find the decision to stand down Ms Parks was reasonable management action, taken reasonably, particularly in circumstances where Ms Parks had presented her employer with a certificate stating she was unfit to work and where she herself was indicating she was unable to work.
  1. [200]
    As a result of that finding, Ms Parks' adjustment disorder is removed from the operation of s 32(1).

Did Ms Parks develop a pain disorder as a result of acquiring her physical injury?

  1. [201]
    Ms Parks' representatives maintain she developed a pain disorder with associated depression:

i) upon acquiring the physical workplace injury; and

ii) as a direct result of the pain suffered because of the physical workplace injury.

  1. [202]
    Again, the Regulator maintains Ms Parks' appeal should be dismissed in circumstances where:
  1. (i)
    insofar as Ms Parks' psychiatric or psychological disorder is causally connected with the accepted physical injury, that injury is not the major significant contributing factor; and
  1. (ii)
    Ms Parks' injury is otherwise excluded by the reasonable management action provisions of the Act.
  1. [203]
    Both Dr Rofe and Dr Hendry maintain Ms Parks is suffering from a pain disorder.
  1. [204]
    In his report dated 8 February 2016, Dr Rofe was of the view Ms Parks developed a chronic pain syndrome; and that her lower back injury was the precipitant for the condition and therefore employment was the major significant contributing factor.
  1. [205]
    Although he had not seen the MRI scans which were initially undertaken of Ms Parks' back at the time of the physical workplace injury, he was of the view that the scans indicated some pathology at the time.
  1. [206]
    Dr Rofe was unable to identify any significant non-work related factors contributing to Ms Parks' diagnosis, but highlighted a number of perpetuating factors in circumstances where she had lost her employment, was experiencing financial difficulties, and her physical condition had impacted on her lifestyle and current relationship.
  1. [207]
    Dr Hendry was of the opinion Ms Parks also met the criteria for a co-morbid pain disorder associated with both psychological factors as well as a general medical condition, chronic in nature. She considered there was an overlap in symptoms for both disorders but it was important to diagnose them separately.
  2. [208]
    Dr Hendry based her opinion in respect of the pain disorder on the coexistence of the initial physical injury – a fall with imaging reporting L4-5 disc prolapse and annular tear (evident on MRI) – having a role as well as psychological factors including Ms Parks' fears of experiencing or exacerbating back pain, her ongoing anger at past employers and specialists, limited psychological insight, limited coping strategies and avoidance behaviours.
  1. [209]
    Dr Hendry considered it was more likely than not that Ms Parks' pain disorder developed shortly after her workplace injury and that it had not resolved at the time of her examination some two and a half years later. She was of the view Ms Parks had some psychological symptoms (presumably associated with the pain disorder) from October 2014 to February 2015.
  1. [210]
    In her report, Dr Hendry made reference to a number of mood and anxiety symptoms (sleep, appetite, energy and anxiety symptoms), noting that they can arise due to pain and a pain disorder rather than an anxiety disorder. However it was not entirely clear, in my view, as to when she considered the symptoms arose and/or how satisfied she was that they were more aligned to the pain disorder rather than some other issue.   
  1. [211]
    She concluded her report noting that workplace stressors were not solely responsible for the development of both disorders (pain and adjustment), but in relation to the pain disorder, it was not entirely clear in her conclusion as to which particular stressors she considered were contributing to the pain disorder and the extent to which she considered they had contributed to the disorder.
  1. [212]
    The difficulty I have with accepting the opinions of both Dr Rofe and Dr Hendry is that they have been established on the available MRI imaging (L4-5 disc prolapse and annular tear) and an acceptance that Ms Parks' fall played a role in the onset of her pain notwithstanding:
  • Dr Gomez told the Commission, the results of the MRI were age appropriate, of limited clinical significance and, by and large, generally degenerative in nature;[89]
  • Dr Baker noted in his oral evidence to the Commission that the MRI findings reported an 'annular tear' incorrectly. Instead, he said the report should have referred to an 'annular fissure'. He explained that annular fissures develop without trauma and that they can be a sign of degenerative change in a disc or something that occurs as the discs get older.[90] Dr Baker was of the view the MRI findings were consistent with someone of Ms Parks' age;[91]
  • Under cross-examination and in response to questions about the source of facetogenic pain, Dr Keys explained the pain could be as a result of degeneration in the facet joints. According to Dr Keys, other causes of the pain could include infection or a strain of the capsule which surrounds the joint;[92] and
  • both Dr Gomez and Dr Baker, who had the benefit of examining Ms Parks at the time of her initial physical injury, were of the view the injury should have resolved before February 2015.
  1. [213]
    To complicate matters further, although Dr Keys expressed the view that the injury sustained by Ms Parks on 14 October 2014 was the cause of her worsening pain and current symptoms, he also noted that other factors that could be contributing to the pain included fibromyalgia, plantar fasciitis, greater trochanter bursitis and adhesive capsulitis.[93]
  1. [214]
    I also note Dr Keys was of the opinion that further investigations should be undertaken so that he could express a more accurate diagnosis or explanation for Ms Parks' pain symptoms.
  1. [215]
    In circumstances where both Dr Rofe and Dr Hendry have largely based their opinions as to what caused Ms Parks' pain disorder on the occurrence of the initial fall and subsequent MRI imaging (L4-5 disc prolapse and annular tear), I am satisfied the preponderance of evidence from the appropriate medical experts in this matter supports a conclusion that any pathology indicated by the MRI is largely degenerative in nature. I am not persuaded that employment (insofar as it is linked to Ms Parks' physical workplace injury) has been the major significant contributing factor in the onset of any pain disorder from which she may now be suffering.

Orders

  1. [216]
    The Commission makes the following orders:
  1. The appeal is dismissed in respect of the claim for both psychological or psychiatric disorders.
  2. The decision of the Respondent dated 28 June 2016 is affirmed.
  3. The Appellant is to pay the Respondent's costs of and incidental to this appeal.

Footnotes

[1] Exhibit 1.

[2] Exhibit 24.

[3] Exhibit 28.

[4] Exhibit 2.

[5] Ibid.

[6] Exhibits 3, 4.

[7] Exhibit 8.

[8] Exhibit 9.

[9] Exhibit 10.

[10] Exhibit 12.

[11] See s 32(5) of the Act.

[12] Exhibit 1.

[13] T1-17.

[14] T1-18.

[15] Exhibit 23.

[16] Exhibit 24.

[17] T1-19.

[18] Ibid.

[19] T2-24.

[20] T2-30.

[21] T1-20.

[22] Exhibit 25.

[23] T3-5, 6.

[24] T3-8.

[25] Exhibit 20.

[26] Exhibit 26.

[27] Exhibit 27.

[28] Exhibit 28.

[29] Exhibit 22.

[30] Exhibit 19.

[31] T2-40.

[32] T2-41.

[33] Exhibit 19.

[34] T2-45.

[35] T2-44.

[36] Exhibit 19.

[37] T2-42.

[38] Ibid.

[39] T3-13.

[40] Ibid.

[41] T3-22.

[42] Exhibit 29.

[43] T3-11.

[44] Exhibit 2.

[45] T1-33.

[46] Exhibit 3.

[47] T2-19.

[48] Ibid.

[49] Ibid.

[50] T2-26.

[51] T2-30, 31.

[52] T2-32.

[53] T1-24.

[54] T1-34, 35.

[55] T2-20.

[56] Exhibit 4.

[57] T2-27.

[58] T2-28.

[59] T2-21.

[60] T1-27.

[61] T1-28.

[62] Exhibit 16 (my emphasis).

[63] T1-61.

[64] Exhibit 12.

[65] T1-62.

[66] Exhibit 13.

[67] T1-66.

[68] T1-63.

[69] Exhibit 14.

[70] Exhibit 15.

[71] T1-65.

[72] Ibid.

[73] T1-66.

[74] Ibid.

[75] Exhibit 30.

[76] Ibid (my emphasis).

[77] Exhibit 11 (my emphasis).

[78] Exhibit 11.

[79] T1-55.

[80] T1-56.

[81] Exhibit 11.

[82] T1-47.

[83] Ibid.

[84] Exhibit 16.

[85] T1-61.

[86] Exhibit 13.

[87] See s 32(5) of the Act.

[88] Exhibit 4.

[89] T3-5, 6.

[90] T2-40.

[91] T2-41.

[92] T1-55.

[93] T1-56.

Close

Editorial Notes

  • Published Case Name:

    Norma Parks v Workers' Compensation Regulator

  • Shortened Case Name:

    Parks v Workers' Compensation Regulator

  • MNC:

    [2018] QIRC 147

  • Court:

    QIRC

  • Judge(s):

    Knight IC

  • Date:

    30 Nov 2018

Appeal Status

Please note, appeal data is presently unavailable for this judgment. This judgment may have been the subject of an appeal.

Cases Cited

No judgments cited by this judgment.

Cases Citing

Case NameFull CitationFrequency
Nathwani v Workers' Compensation Regulator [2021] QIRC 3252 citations
1

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