When a man fainted and fell over in his home, resulting eventually in partial amputation of his leg, he blamed it on dizziness due to the medication he was taking to help him recover from a work injury.
His employer disputed his claim, but a commission ruled his injury was work-related. It referred the matter to an approved medical specialist to assess the extent of the man’s impairment for compensation purposes.
The injuries
In January 2009, the 53-year-old worker was unloading timber from the back of the truck and pulling the straps with force when one of the straps gave way. This made him fall backward onto the floor with great force, with his arms stretched backward. He ‘felt a pop’ in his left shoulder straight away.
The pain did not settle, and over time it got worse. With the stiffness in his shoulder, he was unable to move his left side and struggled to lie in bed because of the severity of the pain. A subsequent ultrasound revealed his injuries and led to repeated surgeries.
Despite post-operative physiotherapy, his pain persisted and he had restricted movement. He was deemed unfit to work as a truck driver and needed vocational rehabilitation.
This made him grieve for the loss of his career and the prospect of being disabled. He reported feelings of hopelessness, worthlessness, and despair. He was prescribed various medications for his pain and depression.
He reported that the medications made him feel lightheaded, with episodes of twitching muscles, tremor, shakiness, and dizziness with sensations of general weakness, losing control, and fear of falling. In February 2012 he fainted and fell over at home. As he fell, his left leg collapsed and became wedged under the sofa, breaking his tibia and fibula. The surgical attempt to repair the damage failed and was complicated, resulting in a bone graft and culminating in below-the-knee amputation of his left leg.
He attributed his fall to excessive dizziness and feeling lightheaded. He was assessed by an independent medical examiner as suffering 36% whole person impairment as a result of both the shoulder and leg injuries.
In March 2020, however, his employer disputed his impairment rating on the grounds that his leg injury was not a consequence of the workplace shoulder injury which had been accepted as compensable.
The case was then heard by the New South Wales Workers Compensation Commission to determine whether the man’s leg injury and subsequent amputation was a consequential condition of the left shoulder injury he sustained at work.
Decision
The commission was required to apply a common-sense evaluation of the causal chain. Medical evidence was put forward asserting that his fall at home may have been due to the side-effects of the interaction between the pain medications and antidepressants he’d been prescribed. The combination of drugs he’d been taking could result in serotonin syndrome, which is associated with a range of symptoms including muscle twitching, headaches, dizziness, muscle weakness, and loss of control.
This was supported by evidence from the man himself, who stated that after the fall he stopped taking all the medications except one, and the dizziness he’d previously experienced had not returned.
Evidence from a different medical practitioner, however, suggested that the fall may have resulted from a ‘presyncopal episode due to postural hypotension’. This refers to a drop in blood pressure upon standing, resulting in the lightheaded sensation that you’re going to faint. This was understood by the arbitrator to describe the mechanism of the fall rather than explaining its cause.
The arbitrator was satisfied that the fall which led to his left leg injury was a consequence of dizziness due to the medication he was taking as a result of his work-related shoulder injury.
The commission ordered the matter to be referred to an Approved Medical Specialist for assessment as to whether the degree of permanent impairment arising from the injury and consequential condition is more than 30%. The result of this assessment will determine the amount of compensation to which the man is entitled.
The bottom line: Whether a non-work injury was a consequence of a work injury depends on a common-sense evaluation of the causal link.
Read the judgment: Rohl v Flincept Pty Ltd [2020] NSWWCC 236 (14 July 2020)
