NSW Workers Compensation Surgery Dispute: When does heavy manual work “cause” a biceps tendon rupture, and when is arthroscopic tenodesis “reasonably necessary” despite a late injury report?

Based on the authentic Australian judicial case Adams v Anakiwa Fishing Pty Ltd [2025] NSWPIC 317, this article disassembles the Court’s judgment process regarding evidence and law. It transforms complex judicial reasoning into clear, understandable key point analyses, helping readers identify the core of the dispute, understand the judgment logic, make more rational litigation choices, and providing case resources for practical research to readers of all backgrounds.

Chapter 1: Case Overview and Core Disputes

Basic Information

Court of Hearing: Personal Injury Commission of New South Wales
Presiding Judge: Member (Commission Member)
Cause of Action: Workers compensation dispute seeking payment of medical treatment expenses for proposed surgery under the Workers Compensation Act 1987 (NSW)
Judgment Date: 3 July 2025
Core Keywords:
Keyword 1: Authentic Judgment Case
Keyword 2: Workers Compensation Act 1987 (NSW)
Keyword 3: Workplace Injury Management and Workers Compensation Act 1998 (NSW)
Keyword 4: Injury and causation under ss 4(a) and 9A
Keyword 5: Reasonably necessary treatment under ss 59 and 60
Keyword 6: Notice of injury and s 254 preclusion

Background

The Applicant worked on commercial fishing vessels in a physically demanding role involving repetitive lifting of heavy boxes of fish, work at sea over long shifts, and cleaning and securing equipment on return to shore. The Applicant later developed an obvious deformity in the right upper arm and reported ongoing weakness and functional limitation. A surgeon recommended a specific operative procedure: biceps tenodesis by open arthroscopic means. The Respondent, through its insurer, disputed whether the condition was a compensable injury arising from employment, disputed whether the proposed surgery was reasonably necessary as a result of any compensable injury, and argued that the claim should fail because notice of injury was not given as required.

This case is a practical illustration of how a tribunal resolves a “classic triangle” dispute in workers compensation: what happened, what the medical evidence truly shows, and whether the worker has met the statutory thresholds for both liability and treatment.

Core Disputes and Claims

The legal focus required the Commission to determine three issues.

1. Injury Issue: Whether the Applicant sustained a personal injury arising out of or in the course of employment and whether employment was a substantial contributing factor to that injury pursuant to ss 4(a) and 9A of the Workers Compensation Act 1987 (NSW).

2. Treatment Issue: Whether the proposed surgery constituted “medical or related treatment” and whether it was “reasonably necessary” as a result of the injury pursuant to ss 59 and 60 of the Workers Compensation Act 1987 (NSW).

3. Notice/Preclusion Issue: Whether the claim was precluded because notice of injury was not given as soon as possible and before the worker voluntarily left employment pursuant to s 254 of the Workplace Injury Management and Workers Compensation Act 1998 (NSW), and if not, whether “special circumstances” applied.

The Applicant sought an order that the Respondent pay the costs of and incidental to the recommended tenodesis procedure. The Respondent sought an award in its favour, denying liability for the surgery costs.

Chapter 2: Origin of the Case

The dispute began, as many workers compensation disputes do, with an ordinary workday turning into a life-altering bodily change.

The Applicant’s working world was defined by physical output. The job required repeated lifting of heavy containers and manual handling under time pressure. Work occurred at sea, away from immediate access to medical care or formal incident reporting systems. The Applicant described a setting in which taking breaks was limited and continuing to work was a practical expectation rather than a negotiable option.

Over time, the Applicant said there were episodes of pain from lifting heavy boxes. In the Applicant’s narrative, raising discomfort was met with instruction to keep working. That pattern matters because it frames why a worker might delay escalating an injury: in some workplaces, raising a problem is perceived as a threat to ongoing work.

The decisive moment occurred during a shift at sea when the Applicant said he was lifting heavy boxes alone and felt pain in the right biceps region. Pain alone is often dismissed by workers as a “strain” that will resolve. However, what later transformed the event from “pain” to “injury” was the appearance of a visible deformity and persistent weakness. That shift from subjective sensation to objective physical signs became central to both causation and credibility.

Soon after, the Applicant sought medical attention. Early medical encounters were not definitive. That is another common feature of litigation: initial consultations may under-diagnose, mislabel, or fail to document key features. The Applicant later obtained imaging and specialist review, leading to a recommendation for surgery.

The Respondent’s account, in contrast, denied that the injury was reported contemporaneously and raised concerns about the Applicant’s credibility and alternative explanations for cessation of employment. The dispute therefore crystallised around whether the tribunal should accept the Applicant’s version and whether the medical evidence supported a workplace mechanism rather than a pre-existing problem.

Chapter 3: Key Evidence and Core Disputes

Applicant’s Main Evidence and Arguments

1. Worker Statements
   The Applicant provided written statements describing:

– the nature of duties on fishing vessels, including repetitive lifting of heavy boxes of fish;
– a particular incident date at sea involving lifting and immediate right biceps pain;
– being told to continue working despite pain;
– later recognition of deformity, persistent symptoms, and inability to return to pre-injury duties;
– subsequent medical attendance and investigations.

1. Hospital Clinical Records
   Hospital records documented presentation with right upper arm pain with a history linked to heavy lifting at work. Importantly, hospital notes included clinician observations consistent with deformity and likely biceps tear, and recorded the Applicant’s intention to lodge a workers compensation claim.

2. General Practitioner Evidence
   A treating general practitioner recorded a diagnosis consistent with a high-grade biceps tendon tear and the history that symptoms started at work, with ongoing incapacity certifications.

3. Treating Orthopaedic Surgeon Evidence
   The treating orthopaedic surgeon observed an obvious “Popeye” deformity and reported MRI findings consistent with long-head biceps rupture, recommending tenodesis and recording the Applicant’s consent to surgical treatment.

4. Independent Medical Evidence (Applicant’s Expert)
   The Applicant’s orthopaedic expert personally reviewed imaging, described a mechanism compatible with a proximal biceps rupture, noted functional weakness, and opined that surgery was reasonably necessary and that delay increased technical difficulty.

Respondent’s Main Evidence and Arguments

1. Employer and Skipper Statements
   The Respondent relied on statements from persons with managerial or supervisory roles who:

– disputed recollection of the incident as described;
– denied that injury was reported;
– challenged the Applicant’s credibility by reference to allegations of drug use and alternative reasons for the employment ending;
– described work patterns involving rest between tasks and asserted the Applicant would not have been lifting alone.

1. Independent Medical Evidence (Respondent’s Expert)
   The Respondent’s orthopaedic expert:

– noted a contour abnormality but was not persuaded of an acute rupture from work;
– expressed concerns about inconsistencies and functional disability claims;
– suggested mental health issues were clouding the presentation;
– recommended further imaging and favoured non-operative management, suggesting surgery would be of limited benefit after time elapsed.

Core Dispute Points

1. What exactly was the pathology: a proximal biceps tendon rupture or merely a cosmetic contour abnormality?
2. Was there a credible, work-related mechanism on a balance of probabilities, particularly in the absence of contemporaneous incident reporting documents?
3. If there was a compensable injury, was the proposed tenodesis surgery “reasonably necessary” to alleviate consequences of injury, rather than merely to improve appearance?
4. Did the Applicant give notice of injury as required by s 254, and if not, do special circumstances prevent preclusion?

Chapter 4: Statements in Affidavits

Although this proceeding involved written statements rather than a contested oral hearing with cross-examination, the functional role was similar to affidavits: each party attempted to convert lived events into admissible, persuasive narrative.

The Applicant’s statement strategy emphasised:
– specificity: naming tasks, describing timing, and recounting the progression from pain to deformity;
– plausibility: explaining why work continued despite pain, and why early medical attendances did not resolve the problem;
– consistency: aligning the narrative with medical histories recorded by clinicians.

The Respondent’s statement strategy emphasised:
– denial and uncertainty: asserting lack of recall and rejecting that the reported incident occurred;
– alternative causation and credibility attacks: implying a pre-existing condition and highlighting alleged drug use as a reason to doubt the Applicant’s reliability and explain employment termination.

The crucial comparison is how each side described the same factual territory:
– The Applicant narrated a coherent chain from heavy lifting, acute pain, continued work under instruction, later recognition of deformity, and documented medical histories.
– The Respondent denied the chain but did so largely through “non-recollection” and collateral allegations rather than a competing, detailed mechanism that better explained the objective physical deformity.

Strategic intent behind procedural directions in cases like this commonly includes ensuring the parties:
– clearly identify statutory issues (injury, causation, treatment necessity, notice);
– disclose medical and factual material early to narrow disputes; and
– focus on the evidentiary chain rather than broad attacks on character that do not directly answer the statutory questions.

Chapter 5: Court Orders

Before final determination, the procedural arrangements in this type of matter typically involve:
– lodgement of an Application to Resolve a Dispute and a Reply;
– provision of supporting documents, including medical reports, clinical notes, imaging, and cost estimates;
– potential applications to lodge additional documents by an insurer;
– listing for conciliation and, if unresolved, arbitration determination;
– case management directions about evidence, including whether any party seeks cross-examination and whether oral evidence will be taken.

In this matter, the dispute proceeded to a conciliation/arbitration format, and no cross-examination was sought and no oral evidence was taken.

Chapter 6: Hearing Scene: Ultimate Showdown of Evidence and Logic

Process Reconstruction: Live Restoration

Even without cross-examination, the “showdown” occurred on paper: medical evidence versus credibility contest; objective clinical observations versus denials of recollection; statutory tests versus rhetorical scepticism.

The Applicant’s side presented a narrative that was anchored in contemporaneous medical histories, consistent descriptions across treating and expert reports, and a visible deformity that demanded explanation. The Respondent’s side countered primarily through:
– disputing the occurrence of the incident,
– suggesting the mechanism was unclear,
– implying pre-existing pathology, and
– arguing that surgery was not warranted due to preserved strength.

The Member’s task was to decide which narrative better matched the totality of the evidence. This is where workers compensation fact-finding becomes practical rather than theoretical: the tribunal asks what most likely happened, not what can be proved like a criminal charge.

Core Evidence Confrontation

The most decisive confrontation was between:
– evidence of a clear “Popeye” deformity and imaging consistent with biceps pathology, and
– the Respondent’s proposition that the condition was not an acute work injury, and that it could be pre-existing or clinically insignificant.

The Commission approached the confrontation through:
1. Pathology Acceptance: deciding whether the Applicant had a proximal biceps tendon rupture.
2. Mechanism and Causation: deciding whether heavy repetitive lifting at work was a substantial contributing factor.
3. Treatment Necessity: deciding whether surgery was reasonably necessary as a result of the accepted injury.
4. Notice: deciding whether the statutory notice barrier applied.

Judicial Reasoning

The Member accepted the Applicant’s expert evidence over the Respondent’s expert where it better explained the objective deformity and aligned with treating evidence. The Member also gave limited weight to collateral allegations about drug use because they were not supported in a way that reliably displaced the core medical and factual chain, particularly where the Respondent’s witnesses struggled with precise recall while still asserting strong denials.

A key statement that was determinative for the injury issue was the tribunal’s emphasis on preferring a coherent, evidence-supported explanation over a speculative alternative that lacked evidentiary foundation.

“Considering the evidence as a whole … I prefer and accept the [Applicant’s] evidence. In the absence of any evidence of pre-existing right arm injury and symptoms and the absence of any alternative explanation for the [Applicant’s] right arm condition, I … am satisfied that the [Applicant’s] employment … provides a logical and likely explanation for his right arm condition.”

This passage matters because it shows the legal technique: the tribunal did not require perfect contemporaneous reporting; it required a persuasive, consistent chain that made sense of the objective medical reality.

Chapter 7: Final Judgment of the Court

The Commission made orders in favour of the Applicant.

• It was determined that the Applicant sustained injury to the right biceps tendon with a date of injury of 20 May 2023 pursuant to ss 4(a) and 9A of the Workers Compensation Act 1987 (NSW).
• It was determined that the recommended surgery, being tenodesis of biceps by open arthroscopic means, was reasonably necessary as a result of the injury pursuant to ss 59 and 60 of the Workers Compensation Act 1987 (NSW).
• It was determined that the Applicant’s claim was not precluded by operation of s 254 of the Workplace Injury Management and Workers Compensation Act 1998 (NSW).
• The Respondent was ordered to pay the costs of and incidental to the recommended surgery pursuant to s 60 of the Workers Compensation Act 1987 (NSW).

Chapter 8: In-depth Analysis of the Judgment: How Law and Evidence Lay the Foundation for Victory

Special Analysis

This case has jurisprudential value because it demonstrates a disciplined approach to resolving three recurring tensions in workers compensation disputes:

1. The “memory gap” problem: employer witnesses may deny events through non-recollection while still mounting a credibility attack. The tribunal tested that stance by examining internal consistency and plausibility.

2. The “objective sign” problem: where an injury has a visible deformity, the tribunal demands an alternative explanation if the employer disputes work causation. Mere scepticism is not a substitute for evidence.

3. The “treatment vs appearance” problem: surgery can be framed by respondents as cosmetic. The tribunal insisted on the statutory question: does the treatment have the purpose and potential effect of alleviating consequences of injury?

4. The “notice trap” problem: s 254 can be invoked as a technical barrier. The tribunal treated notice as a practical inquiry, focusing on what was said, when the worker understood the extent of injury, and whether the employer was truly prejudiced.

Judgment Points

1. Preference of medical opinion is not a popularity contest; it is an explanation contest. The tribunal preferred the medical opinion that best explained the objective deformity, aligned with treating evidence, and coherently matched the imaging limitations.

2. Credibility is assessed through evidentiary architecture. The tribunal looked at detail, consistency across medical histories, and the absence of a credible alternative explanation rather than treating denial as determinative.

3. “Reasonably necessary” is not “absolutely necessary”. The tribunal applied the well-established approach that treatment may still be reasonably necessary if it is prudent and appropriate to alleviate injury consequences, even if alternative management exists.

4. The tribunal can reject “cosmetic-only” framing where function, weakness, and capacity evidence supports a therapeutic purpose, including return-to-work prospects.

5. Notice is not a mechanical box-tick. Verbal notice can satisfy s 254 if it is given as soon as possible and before voluntary leaving, particularly where dismissal occurs and the worker did not fully appreciate the physical extent immediately.

Legal Basis

The legal reasoning was built around specific statutory provisions and established authorities:

• Workers Compensation Act 1987 (NSW) s 4: definition of injury, including “personal injury arising out of or in the course of employment”.
• Workers Compensation Act 1987 (NSW) s 9A: substantial contributing factor test for non-disease injury, with examples of relevant factors.
• Workers Compensation Act 1987 (NSW) ss 59 and 60: entitlement to payment of reasonably necessary medical treatment as a result of injury.
• Workplace Injury Management and Workers Compensation Act 1998 (NSW) s 254: notice requirements and special circumstances exceptions.

For causation and evidentiary approach, the tribunal referenced:
– Kooragang Cement Pty Ltd v Bates (1994) 35 NSWLR 452; 10 NSWCCR 796, emphasising a commonsense evaluation of the causal chain.
– Comcare v Martin [2016] HCA 43, noting concerns in Commonwealth context while maintaining the approach’s place in the state statutory setting.
– Nguyen v Cosmopolitan Homes [2008] NSWCA 246 and Department of Education & Training v Ireland [2008] NSWWCCPD 134, emphasising “actual persuasion” on balance of probabilities.

For “reasonably necessary” medical treatment:
– Rose v Health Commission (NSW) (1986) 2 NSWCCR 32, articulating the prudence and good sense test and the factors to be considered.
– Diab v NRMA Ltd [2014] NSWWCCPD 72, restating and applying the Rose framework.
– Bartolo v Western Sydney Area Health Service (1997) 14 NSWCCR 233, reinforcing the practical question: should the patient have the treatment?
– Murphy v Allity Management Services Pty Ltd [2015] NSWWCCPD 49, emphasising that the work injury need not be the only cause for the treatment, and that material contribution suffices.

Evidence Chain

The Commission’s logic can be expressed as a five-link structure.

1. Statutory Provisions
   The Applicant needed to satisfy ss 4(a) and 9A for injury and ss 59 and 60 for treatment. The Respondent sought to invoke s 254 to defeat the claim.

2. Evidence of Pathology
   Objective signs were powerful: the Popeye deformity observed by specialists and recorded in reports, together with MRI findings showing biceps tendon fibre attenuation and the absence of the long head biceps in the expected anatomical location as interpreted by one expert.

3. Consistency of History
   The Applicant’s mechanism of injury was repeated across multiple medical contexts: hospital attendance and GP records and specialist review, which reduced the probability of later fabrication.

4. Competing Expert Opinions
   One expert questioned the mechanism and minimised disability; the other directly connected repetitive heavy lifting to rupture and supported surgery to improve weakness and function. The tribunal preferred the opinion consistent with treating evidence and the objective deformity.

5. Practical Workplace Context
   The work environment at sea, the physical nature of tasks, and the absence of evidence of pre-existing symptoms formed the contextual scaffold for a finding that employment was a substantial contributing factor.

Judicial Original Quotation

The tribunal’s treatment reasoning applied the established test that focuses on alleviating injury consequences and assesses necessity with prudence, sound judgment and good sense.

“The question is should the patient have this treatment or not. If it is better that he have it, then it is necessary and should not be forborne. If in reason it should be said that the patient should not do without this treatment, then it satisfies the test of being reasonably necessary.”

This statement is determinative because it neutralises a common respondent tactic: reframing the issue as “not strictly necessary”. The tribunal’s approach demands a realistic, patient-centred assessment grounded in medical appropriateness and likely benefit, not an insurer’s preference for minimal expenditure.

Analysis of the Losing Party’s Failure

The Respondent’s position failed for reasons that are instructive for future litigation.

1. Failure to provide a credible alternative explanation
   The Respondent disputed the occurrence of the incident, yet did not provide persuasive evidence explaining the objective deformity if it was not caused by work. In compensable injury disputes, denial must be anchored in an alternative narrative with evidentiary support, not merely disbelief.

2. Over-reliance on credibility attacks divorced from statutory issues
   Allegations about drug use were deployed to erode credibility. The tribunal gave that material limited weight in circumstances where it did not directly explain the injury pathology and where the Respondent’s witnesses themselves had difficulty recalling crucial details.

3. Expert opinion not accepted because diagnosis did not fit the totality
   The Respondent’s expert was not accepted on the central diagnosis. Once the tribunal preferred a rupture diagnosis, the non-operative and “cosmetic-only” surgery critique lost much of its force.

4. Insufficient engagement with the Rose/Diab framework
   To defeat a s 60 claim, a respondent must grapple with appropriateness, alternatives, cost, likely effectiveness, and medical acceptance. Where alternatives are asserted, they must be identified and shown to be likely effective for the condition in question. General statements that “surgery is not required” are rarely enough.

5. Notice argument did not overcome practical findings
   The tribunal accepted that verbal notice likely occurred and, alternatively, that special circumstances applied. A respondent relying on s 254 needs to demonstrate prejudice or show that the worker’s delay was not reasonably explained. Here, the tribunal accepted that the worker may not have appreciated the extent until later and that employer knowledge arose within a relatively short period.

Key to Victory

The Applicant’s victory depended on combining the right kind of evidence with the right statutory framing.

• The most critical evidence was objective: visible deformity, specialist examination findings, and imaging.
• The most critical narrative feature was consistency: the same mechanism was reported repeatedly in medical settings.
• The most critical legal strategy was alignment: presenting the case as “Conclusion = Evidence + Statutory Provisions”, with each factual claim tied to a specific element of ss 4(a), 9A, and 60.
• The most decisive medical strategy was explaining function: the surgery was framed as addressing weakness and restoring capacity, not merely correcting appearance.

Reference to Comparable Authorities

Kooragang Cement Pty Ltd v Bates (1994) 35 NSWLR 452; 10 NSWCCR 796
Ratio Decidendi Summary: Causation in workers compensation is assessed by a commonsense evaluation of the causal chain; an injury can set in train a series of events, and the issue is a question of fact on the evidence.

Nguyen v Cosmopolitan Homes [2008] NSWCA 246
Ratio Decidendi Summary: Findings on balance of probabilities require actual persuasion of the fact’s existence; a rational choice between competing hypotheses can support a finding even where not all alternative hypotheses are excluded.

Rose v Health Commission (NSW) (1986) 2 NSWCCR 32
Ratio Decidendi Summary: Treatment is reasonably necessary if, applying prudence and good sense, it should be afforded to alleviate injury consequences; assessment includes appropriateness, alternatives, cost, effectiveness, and medical acceptance.

Diab v NRMA Ltd [2014] NSWWCCPD 72
Ratio Decidendi Summary: Reaffirmed and applied the Rose criteria; “reasonably necessary” does not mean “absolutely necessary”, and a worker need only show that the claimed treatment is within the range of reasonably necessary options.

Murphy v Allity Management Services Pty Ltd [2015] NSWWCCPD 49
Ratio Decidendi Summary: For s 60, the work injury need not be the only cause; it is sufficient that the injury materially contributed to the need for treatment, assessed by a commonsense test of causation.

Implications

1. Pain is not always persuasive; objective change is. If you experience a sudden change in shape, strength, or function, document it early and seek imaging promptly. A visible deformity often becomes the anchor point around which the legal case turns.

2. Consistency beats perfection. Many workers fear they have “messed up” their claim because early medical visits did not capture everything. Courts and tribunals look for an overall coherent pattern: repeated histories across different clinicians can carry significant weight.

3. Reasonably necessary treatment is a practical question. The law does not demand that surgery be indispensable. It asks whether, applying sound judgment, you should not be made to go without it when it offers real therapeutic benefit.

4. Notice is about real life, not paperwork worship. If you told a supervisor and the workplace later learned of the injury through medical channels, the notice issue may not be fatal. The key is acting as soon as reasonably possible, especially once you understand the injury’s seriousness.

5. Employers and insurers must meet evidence with evidence. Denial, disbelief, and insinuation rarely defeat a well-supported medical and factual chain. The most powerful response is a credible alternative explanation, properly proved.

Q&A Session

1. If there is no incident report completed on the day, can a worker still prove a workplace injury?
   Yes, if the worker can persuade the tribunal on balance of probabilities through a coherent evidence chain. Consistent medical histories, contemporaneous clinical records, objective signs, and plausibility of mechanism can overcome the absence of an internal report.

2. What does “reasonably necessary” medical treatment really mean in workers compensation?
   It means that, applying prudence and good sense, the treatment should be afforded to alleviate the consequences of injury. It does not require that the treatment be indispensable. The tribunal considers medical appropriateness, alternatives, cost, likely effectiveness, and whether the treatment is accepted in usual medical practice.

3. What if the worker did not immediately appreciate the seriousness of the injury and delayed formally notifying the employer?
   The notice provisions require notice as soon as possible, but the law also recognises special circumstances that prevent strict technical preclusion. If the delay is reasonably explained, if the employer was not prejudiced, or if the employer learned of the injury from other sources relatively soon, preclusion may not apply.

Appendix: Reference for Comparable Case Judgments and Practical Guidelines

1. Practical Positioning of This Case

Case Subtype: NSW Workers Compensation – Claim for payment of proposed surgical treatment expenses under s 60
Judgment Nature Definition: Final determination of a medical treatment dispute (liability for future surgery costs)

2. Self-examination of Core Statutory Elements

This section provides structured reference tests for evaluating a matter of this type. These are for reference only. Outcomes tend to be determined by the specific evidence, the statutory framework, and how the tribunal assesses the competing narratives.

Core Test Standard: Injury (Workers Compensation Act 1987 (NSW) ss 4(a) and 9A)

Step 1: Identify the alleged injury precisely
– Define the pathology as a medical condition capable of being characterised as an injury, such as a proximal biceps tendon rupture.
– Gather treating diagnoses, imaging reports, and objective clinical findings.
– Consider whether the evidence is consistent over time, including whether early notes record the same mechanism.

Step 2: Establish that the injury arose out of or in the course of employment (s 4(a))
– Prove a temporal and situational connection between work and the onset or aggravation of symptoms.
– Focus on the “time and place” of the injury and what tasks were being performed.
– Document the specific physical actions, weight handled, repetition, posture, and environment.

Step 3: Prove employment was a substantial contributing factor (s 9A)
– Address the statutory examples as practical prompts:
– the time and place of the injury;
– the nature of the work performed and tasks involved;
– the duration of employment;
– the probability the injury would have happened anyway at about the same time or stage of life absent work;
– the worker’s state of health before the injury and hereditary risks;
– the worker’s lifestyle and activities outside the workplace.
– Assemble evidence that reduces the likelihood of non-work explanations, such as absence of prior symptoms, absence of competing injury events, and continuity of complaints linked to work tasks.

Step 4: Meet the balance of probabilities standard with actual persuasion
– Ensure the evidence is not merely possible but more probable than not.
– Where there are competing hypotheses, present a rational basis for preferring the work-related hypothesis, supported by contemporaneous medical histories and objective features.

Core Test Standard: Medical Treatment (Workers Compensation Act 1987 (NSW) ss 59 and 60)

Step 1: Identify the treatment as medical or related treatment
– Confirm that the claimed item is medical treatment, such as a surgical procedure, and identify precisely what is proposed and why.

Step 2: Prove the treatment is reasonably necessary
Apply the Rose and Diab approach as a structured checklist:
– Appropriateness: Is the treatment clinically appropriate for the condition?
– Alternatives: Are there alternative treatments, and are they likely to be effective for this condition?
– Cost: Is the cost within a reasonable range relative to expected benefit?
– Effectiveness: What actual or potential improvement is expected, including pain reduction, strength improvement, functional restoration, and capacity for work?
– Medical acceptance: Is the treatment part of the usual medical armoury, supported by specialist opinion?

Step 3: Prove the need arises as a result of the work injury
– Demonstrate that the injury materially contributed to the need for the treatment.
– If there are potential multiple causes, address them transparently and show why the work injury remains a material contributing cause.

Core Test Standard: Notice of Injury (Workplace Injury Management and Workers Compensation Act 1998 (NSW) s 254)

Step 1: Notice given as soon as possible after the injury happened
– Identify what was said, to whom, and when.
– Verbal notice may be relevant, but it tends to be assessed against credibility and surrounding circumstances.

Step 2: Notice given before the worker voluntarily left employment
– Establish whether the worker voluntarily left or was dismissed.
– Where dismissal occurs, the “voluntary leave” element may not be satisfied against the worker.

Step 3: If notice is disputed, analyse special circumstances (s 254(2) and s 254(3))
Special circumstances can include:
– lack of prejudice to the employer;
– delay due to ignorance, mistake, absence, or other reasonable cause;
– employer knowledge of the injury from any source at or about the time;
– other statutory circumstances listed in s 254.

This assessment tends to be fact-sensitive. The tribunal may accept that a worker did not appreciate the extent of injury immediately, especially where the key symptom became clear only later.

3. Equitable Remedies and Alternative Claims

This case sits within a statutory workers compensation framework. Equity does not typically replace statutory entitlements, but there are adjacent legal pathways that can become relevant if the statutory avenue is exhausted or if additional relief is sought.

Procedural Fairness

Where an insurer or decision-maker refuses liability or treatment without giving a fair opportunity to respond, procedural fairness concepts may arise in review contexts. A worker may need to consider:
– whether reasons were properly explained,
– whether relevant evidence was ignored, and
– whether the process involved a denial of a meaningful opportunity to address adverse material.

These arguments tend to be stronger where there is clear documentary evidence of unfair procedure rather than disagreement on medical judgment.

Misleading or Unfair Handling (Practical, Not Absolute)

In some cases, a worker may believe they were misled about rights or discouraged from reporting. While this does not automatically create an equitable remedy against the statutory framework, it can become relevant in explaining delay, credibility, and reasonableness for notice issues. It may also inform complaints processes about claims handling conduct.

Common Law Negligence and Work Injury Damages (Only Where Applicable)

Some workers may explore work injury damages claims where negligence can be established, but thresholds and procedural requirements apply, and the availability depends on the jurisdictional regime and injury severity. This is not an automatic pathway and tends to be highly fact-dependent.

4. Access Thresholds and Exceptional Circumstances

Regular Thresholds

• Proof of injury and causation: The worker must satisfy ss 4(a) and 9A on balance of probabilities, which tends to require coherent factual narrative and medical support.
• Reasonably necessary treatment: The worker must satisfy the Rose and Diab framework under s 60.
• Notice: s 254 requires notice as soon as possible and before voluntary leaving.

Exceptional Channels

• Notice special circumstances: Even where notice is imperfect, s 254(2) and s 254(3) can prevent preclusion where delay is reasonably explained, employer prejudice is absent, or employer knowledge arose from another source within a reasonably short period.
• Medical complexity: Where imaging is incomplete (for example, scans not extending far enough to capture the full tendon retraction), the tribunal may accept a diagnosis supported by specialist review and objective examination, provided the reasoning is persuasive.

Suggestion: Do not abandon a potential claim simply because you do not meet an idealised reporting timeline. Compare your circumstances against the statutory exceptions and assemble evidence explaining why delay occurred. Many cases turn on whether the tribunal sees the delay as understandable rather than strategic.

5. Guidelines for Judicial and Legal Citation

Citation Angle

It is recommended to cite this case in legal submissions or debates involving:
– how a tribunal weighs competing orthopaedic opinions where objective deformity is present;
– application of ss 4(a) and 9A to heavy manual handling work with limited contemporaneous reporting;
– the approach to “reasonably necessary” surgery under s 60 where a respondent argues the procedure is cosmetic or not required;
– the operation of s 254 notice requirements where verbal notice is alleged and where the worker’s appreciation of injury extent developed over time.

Citation Method

As Positive Support: When your matter involves a worker with a consistent medical history, objective clinical findings, and a coherent mechanism tied to work tasks, this authority can support an argument that the injury and treatment are established on balance of probabilities.

As a Distinguishing Reference: If the opposing party cites this case, emphasise uniqueness such as materially different medical pathology, stronger evidence of pre-existing symptoms, clear alternative non-work mechanisms, or demonstrated employer prejudice from delayed notice. Those differences may support an argument that the reasoning does not apply.

Anonymisation Rule: In submissions and public commentary, use procedural titles such as Applicant and Respondent rather than personal names, consistent with the requirements of professional presentation.

Conclusion

This decision shows how statutory workers compensation disputes are won: not by louder denial, but by a coherent chain that links work duties to objective injury and links objective injury to prudent, accepted treatment.

Everyone needs to understand the law and see the world through the lens of law. The in-depth analysis of this authentic judgment is intended to help everyone gradually establish a new legal mindset: True self-protection stems from the early understanding and mastery of legal rules.

Disclaimer

This article is based on the study and analysis of the public judgment of the Personal Injury Commission of New South Wales (Adams v Anakiwa Fishing Pty Ltd [2025] NSWPIC 317), aimed at promoting legal research and public understanding. The citation of relevant judgment content is limited to the scope of fair dealing for the purposes of legal research, comment, and information sharing.

The analysis, structural arrangement, and expression of views contained in this article are the original content of the author, and the copyright belongs to the author and this platform. This article does not constitute legal advice, nor should it be regarded as legal advice for any specific situation.

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