This decision illustrates a familiar problem faced by claimants, lawyers and doctors: if a patient suffers an injury, and later presents with ongoing problems and symptoms in the same body part, are those ongoing problems related to the accident and therefore compensable? The answer is simply that it depends on the evidence, more particularly a clear explanation by the treating doctors. This Appeal Court decision illustrates the danger for clients who claim the cost of treatment and related damages on the basis that ongoing medical problems in the same body part are more likely than not casually related to the accident and rely on the simple say-so, even contained in written reports, by their treating surgeon.
In this case Ms Lang suffered injuries to her Left arm in 2007. The insurer accepted liability and paid for her treatment and time from work. Her left arm really never recovered. She continued to have left arm problems and suffered notable aggravations in 2009 and 2010. The surgeon continued with treatment and ultimately recommended a fusion of her left wrist. The insurer refused to fund the surgery arguing that the need for that surgery arose out of a medical condition that was not an injury that was suffered in the work accident. WorkCover ordered the insurer to pay, the insurer appealed to the District Court and the appeal Judge upheld the arbitrator’s finding. The insurer challenged the decision to the Supreme Court and won. The insurer won on the basis that on a careful analysis of the medical history and opinion that the initial injury could be characterised as a nerve injury, but the condition for which she required fusion surgery was a wrist impaction injury, a completely different type of injury, and critically an injury not proven to be related to the 2007 accident which was the subject of the claim.
The lesson from this case is that in any claim by a Client for funding for treatment or other benefits, clear medical evidence must be presented that explains, not simply alleges, how and why the ongoing symptoms relate to the original injury and how the proposed treatment will be beneficial. The mere say-so by a client’s doctor that the treatment is needed because of the accident is just not good enough. Insurers and their lawyers are likely to take a far more active interest in the medical explanation provided by doctors as to the connection between the injury and the need for treatment and WorkCover and will analyse the underlying explanations before ordering payment of benefits. On a related note in this case the Supreme Court made a point about the failure of the medical reports to clearly explain the medical findings and conclusions in easily understandable terms. The Court took a very active interest in what the doctors were reporting and was very keen to understand the rationale of the doctor’s thinking. Clients should be careful that the report on which they rely are easy to understand, define complex terms, and are logical and scientifically sound.