Tribunal found the worker's pain resulted from a separate, underlying condition
In a recent decision, the Administrative Appeals Tribunal considered whether a worker was eligible to continue to receive compensation in respect of a 2015 shoulder injury. This case highlights that to continue to receive workers’ compensation, an employee’s injury must continue to result from the original incident rather than an underlying condition.
The employee worked at the Department of Human Services (now Services Australia). In October 2015, they sustained a right shoulder injury after opening a faulty fire door at work. Comcare accepted liability to pay workers’ compensation for a partial tear of the employee’s right rotator cuff. Over the next few years, they underwent numerous treatments.
In February 2020, Comcare determined that it was no longer liable for the employee’s medical treatments, incapacity benefits, and household and attendant care. The employee sought a review of Comcare’s decision in the Administrative Appeals Tribunal.
Comcare relied on the evidence of Professor Peter Steadman to submit that the employee suffered only a “musculoskeletal sprain” in October 2015, which did not bring about any physiological change, and should never have been considered an “injury” under the legislation. It also asserted that if the employee did sustain an “injury” from the incident, it would have healed within four to six weeks. Comcare contended that, from that point on, the employee’s pain was attributed to a separate, underlying condition.
In contrast, the employee stated that whether or not Comcare should have accepted his condition at the time was irrelevant. He also submitted that the estimated recovery timeframes outlined by Comcare were based on averages and not specific to his case.
Ultimately, the Tribunal preferred Comcare’s evidence to that of the employee. This was based partly on the evidence of several specialists, who opined that the June 2016 surgery revealed an underlying condition in QXQH’s right shoulder caused by a 2006 injury.
With this, the Tribunal found that the events of October 2015 caused a musculoskeletal sprain, which did not result in an “injury” under the legislation. It held that the employee’s present pain was likely attributed to complications linked to the two subsequent surgeries.
The Tribunal affirmed Comcare’s decision to reject liability.
Where an employee’s injury arises from a pre-existing or underlying condition, they may not be eligible to receive workers’ compensation
