The ambits of workers compensation are boundless, especially in cases of ‘consequential conditions.’
Consequential conditions refer to medical conditions that arise as a result of an initial workplace injury or illness. These conditions are not part of the original injury but develop due to its physical, psychological, or functional impacts. Fundamentally, injured workers bear the onus to prove the existence of such a condition.
How do they occur?
Although each case is unique, often a consequential condition may be sustained as a result of overcompensation, overuse or substitution of a particular limb or body part. For example, if you have sustained an injury to your right shoulder and begin to overcompensate with your left shoulder, you may be entitled to lodge a claim with respect to the consequential condition. Alternatively, an employee recovering from a workplace back injury may later develop a mental health condition, such as anxiety or depression, stemming from chronic pain or reduced mobility. Similarly, an altered gait caused by the initial injury could lead to subsequent problems in other parts of the body, such as the knees or hips.
The workers' compensation scheme acknowledges these conditions as compensable, provided a clear causal link is established between the initial injury and the consequential condition. Understanding the framework for claiming consequential conditions is essential, as it ensures injured workers receive comprehensive support and treatment for all health issues arising from their work-related injury. This aspect of the scheme plays a critical role in safeguarding workers’ well-being and helping them return to optimal functionality.
Notwithstanding this, the above examples are not exhaustive. Even if you think that the condition may be farfetched, it probably isn’t. Conditions that have and continue to transpire are limitless. In fact, there are a series of cases where the insurer has accepted liability, despite the peculiarity. For example, unexpected weight gain resulting from excessive medication usage could be deemed a consequential condition.
Causation Test
The Workers Compensation Act 1987 (NSW) does not define a consequential condition and investigation of such entitlements is on a case-by-case basis. Leading authorities such as Kumar,1 Moon2 and Kooragang3 provide guidance in establishing key principles in this area of law. Particularly, in the case of Kooragang, the Court explored the issue of causation, developing the ‘results from’ test.
What does this mean for consequential conditions?
Essentially, the ‘results from’ test lowered the threshold required in proving a consequential condition injury, which differs significantly from the threshold required to prove a ‘personal injury.’ In cases where a consequential condition is yet to be determined, not only will it be considered on a situational basis, but the worker will only need to prove that the original injury had a material contribution to the second injury.
Case Study
In the case of Aylott v Lite N' Easy [2024] NSWPIC 601, Walker Law Group succeeded in proving the existence of a consequential condition.
On 28 October 2024, the Personal Injury Commission ordered that the insurer accept liability for the applicant's consequential hip condition and pay for any medical, surgical, hospital and related treatment expenses associated with the right hip condition.
For contextual purposes, the applicant sustained a workplace injury to her lumbar spine in 2018. After sustaining the injury, the applicant faced a number of complications, namely in relation to mobility, sitting and standing which she reported to her medical practitioner.
The applicant had stated that her lumbar spine had caused significant weakness and numbing to her right leg. Not only did she experience a loss of sensation, but pain radiated down to her right leg. The applicant reported experiencing episodes where she felt at risk of falling and specifically noted an instance in which she did fall as a result of the weakness. To the extent she used a walking stick and walker to assist with her mobility. This was all reported and subsequently documented by her GP.
On 11 October 2023, the applicant entered the kitchen of her home. While she was walking in her kitchen, her leg suddenly gave way, causing her to fall onto the tiled floor, immediately fracturing her right hip. The applicant was rushed to hospital and subsequently a right hip replacement surgery was performed.
When the applicant made a claim for a consequential hip condition, the insurer disputed the claim on the basis that there was not a sufficient causal nexus between the lumbar (accepted injury) spine and the right hip.
At the Personal Injury Commission, the matter was determined by Member Diana Benk who concluded that “the applicant [had] established on the balance of probabilities, and with a degree of actual persuasion and affirmative satisfaction that she [had] suffered the consequential condition to the right lower limb (hip) as a result from her accepted back injury.”4
