The Court of Appeal has recently decided a matter in favour of an injured worker who required a total knee replacement in the matter of Pacific National Pty Ltd v Baldacchino.
In this case, the worker suffered a work related injury to his left knee in 1999.
In 2016, his orthopaedic specialist recommended a total knee replacement. The workers compensation insurer denied the claim on the basis that it did not fall within the meaning of “artificial member” or an “artificial aid” under the relevant legislation and therefore was not compensable.
The insurer argued that an “artificial aid” was something that is external to the body. However, the Court did not accept this argument as there was nothing within the natural meaning of “aid” that requires it to be external to the body.
A further argument raised by the insurer was that the compensation was payable for the prosthetic materials only and not for the surgery that was required.
This was also rejected by the Court because the provision of the artificial aid in the form of a total knee replacement requires surgery.
Therefore there is no time limitation on claiming surgery for replacement of joints with prosthetic materials.
If you have been injured at work and require surgery, but the insurer will not agree to fund the cost, please contact Anthony Frisina on 9602 4999 to discuss as Frisina Lawyers may be able to help.
If you have a viable case, we will seek legal funding from WIRO, so there will be no cost to you for our services.