CERTIFICATE OF DETERMINATION OF MEMBER  	
	
Citation:	Kelly v Laverty Pathology [2025] NSWPIC 263	
		
APPLICANT:	Jayne Kelly	
		
RESPONDENT:	Laverty Pathology	
		
Member:	Mitchell Strachan	
		
DATE OF DECISION:	12 June 2025	
		
CATCHWORDS:	WORKERS COMPENSATION - Workers Compensation Act 1987; disease injury; consequential condition; standard of proof; section 140 of the Evidence Act 1995; Nguyen v Cosmopolitan Homes and Mead v Kearney considered and applied; El-Chami v DME Engineering Services Pty Limited applied; incapacity; onus to establish capacity for suitable employment where incapacity established; Held – award for applicant on injury to right thumb and consequential condition to left thumb; award for respondent on injury and consequential condition to right wrist, left wrist, left elbow and Dupuytren contracture to both hands; award for applicant on claim for weekly compensation and medical expenses.	
determinations made:	The Commission determines:
Findings: 
1.	The applicant sustained an aggravation injury to her right thumb in the course of her employment with the respondent and as a result of the right thumb injury a consequential condition to her left thumb with a deemed date of injury of 15 May 2023. 
2.	The applicant has not discharged her onus in establishing injury or consequential condition to the right wrist, left wrist, left elbow or with respect to Dupuytren contracture in either the left or right hands.  
3.	As a result of injury to the left and right thumbs the applicant suffers an incapacity for her pre-injury employment. 
4.	The respondent has not discharged its onus, on the evidence before the Commission, in establishing suitable employment. 
5.	The applicant has no current work capacity.   
Orders:
6.	Award for the applicant on the issue of injury to the right thumb and consequential condition to the left thumb. 
7.	Award for the respondent on the issue of injury to the right wrist, left wrist, left elbow and Dupuytren contracture in either the left or right hands. 
8.	The respondent to pay the applicant weekly compensation from 18 December 2023 to date and continuing pursuant to ss 37 and 38 of the Workers Compensation Act 1987 as follows: 
(a)	from 18 December 2023 to 30 March 2024 at the rate of $565.60 per week;
(b)	from 1 April 2024 to 30 September 2024 at the rate of $576 per week;
(c)	from 1 October 2024 to 30 March 2025 at the rate of $587.20 per week, and
(d)	from 1 April 2025 to date and continuing at the rate of $589.60 per week.
9.	The parties have liberty to apply within 14 days with respect to the quantification and indexation of the entitlement to weekly compensation. 
10.	The respondent to pay the applicant’s reasonably necessary medical and treatment expenses with respect to injury to the left and right thumbs.  

A brief statement is attached setting out the Commission’s reasons for the determination.

STATEMENT OF REASONS
BACKGROUND
1.	The applicant was employed by the respondent, since 1991, as a pathology collector. In 2021, as a result of the COVID-19 pandemic, her duties changed and she was administering PCR swab tests. 
2.	The applicant initially developed pain in her right thumb, she says as a result of pushing and removing corks from test tubes repetitively. The fact she sustained an injury to her right thumb in the course of her employment with the respondent is not in dispute in these proceedings. However, the applicant also alleges she sustained an injury or a consequential condition to her left thumb, both wrists, a condition known as Dupuytren’s contracture in both hands and left tennis elbow. 
3.	While the injury to the right thumb is not disputed, the significant issue in these proceedings is whether the evidence relied on by the applicant is sufficient for her to discharge her onus in establishing the various injuries and consequential conditions alleged. 
4.	The applicant further alleges that these injuries have caused her incapacity for work and makes a claim for weekly compensation which is disputed by the respondent. 
ISSUES FOR DETERMINATION
5.	During conciliation, the applicant withdrew her claim for lump sum compensation. 
6.	The applicant however maintains her claim for weekly compensation from 
18 December 2023 to date and continuing with pre-injury average weekly earnings (PIAWE) agreed at $707 per week (subject to indexation) and for medical expenses with respect to injury to her right thumb, right wrist, left thumb, left wrist, left elbow and Dupuytren contracture effecting both hands. 
7.	Injury to the right thumb is not in dispute. The parties agree that the relevant deemed date of injury is 15 May 2023. 
8.	The parties agree that the following issues remain in dispute:
(a)	injury to right wrist, left thumb, left wrist, left elbow and Dupuytren contracture in both hands due to the nature and conditions of the applicant’s employment and in the alternative consequential to the injury to the right thumb;
(b)	entitlement to and quantification of claim for weekly compensation, and
(c)	entitlement to medical expenses however the parties agreed that a general order was appropriate where liability is determined in favour of the applicant on the issue of injury.  
PROCEDURE BEFORE THE PERSONAL INJURY COMMISSION
9.	The matter was listed before me for conciliation conference and arbitration hearing on 
13 May 2025 by MS Teams. Mr Murray, solicitor appeared for the respondent. Ms Chen attended on behalf of the self-insured respondent. Mr Grimes of counsel appeared for the applicant, instructed by Ms Guirguis of LHD Lawyers. The applicant was also in attendance. 
10.	I am satisfied that the parties to the dispute understand the nature of the application and the legal implications of any assertion made in the information supplied.  I have used my best endeavours in attempting to bring the parties to the dispute to a settlement acceptable to all of them.  I am satisfied that the parties have had sufficient opportunity to explore settlement and that they have been unable to reach an agreed resolution of the dispute.  
EVIDENCE
Documentary evidence
11.	The following documents were in evidence before the Personal Injury Commission (Commission) and considered in making this determination: 
(a)	Application to Resolve a Dispute and attached documents;
(b)	Application to Lodge Additional Documents dated 11 April 2025 attaching the respondent’s reply and attached documents, and
(c)	applicant’s Application to Lodge Additional Documents dated 7 May 2025. 
FINDINGS AND REASONS 
12.	There is no dispute the applicant sustained an injury to the right thumb in the course of her employment with the respondent and liability have been accepted by the respondent’s insurer with respect to that injury. The parties have agreed that the injury being a disease injury, the correct date of injury is deemed date of 15 May 2023. 
13.	The applicant alleges injury to her left thumb, right wrist, left wrist, left elbow and Dupuytren contracture in both hands primarily resulting from the nature and conditions of her employment and in the alternative as a consequential condition resulting from her accepted right thumb injury. 
14.	While I will provide reasons for my findings with respect to each body part claimed under the relevant hearings below, it is convenient to first set out the principles relevant to my consideration as they apply equally to each body part.  
15.	Firstly, it is important that the applicant carries the onus of establishing injury to each body part. 
16.	As the applicant is alleging injury as result of a disease process, she must establish that employment was the main contributing factor to contracting the disease or that employment was the main contributing factor to the aggravation, acceleration, exacerbation or deterioration of the disease.  
17.	In establishing her alternative argument that the relevant conditions are consequential to the right thumb injury, the applicant must establish, on a commonsense basis (of the nature discussed in Kooragang Cement Pty Limited v Bates (1994) 35 NSWLR 452), that the condition results from the accepted right thumb injury. She is not required to establish injury within the meaning of s 4 of the Workers Compensation Act 1987 (the 1987 Act) independently of the accepted right thumb condition. 
18.	Secondly, the findings that the applicant is asking the Commission to make must be supported by evidence which is before the Commission and I must be satisfied that the applicant has met her onus on the balance of probabilities. While the rules of evidence do not apply in the Commission, I can take some guidance from the principles set out in s 140 of the Evidence Act 1995 which provides: 
“(1) 	In a civil proceeding, the court must find the case of a party proved if it is satisfied that the case has been proved on the balance of probabilities.
(2) 	Without limiting the matters that the court may take into account in deciding whether it is so satisfied, it is to take into account:
(a) 	the nature of the cause of action or defence, and
(b) 	the nature of the subject-matter of the proceeding, and
(c) 	the gravity of the matters alleged.”
19.	In reaching a finding of fact, I must feel an actual persuasion or comfortable satisfaction. As discussed by the Court of Appeal in Nguyen v Cosmopolitan Homes [2008] NSWCA 246 this approach requires: 
“(1) A finding that a fact exists (or existed) requires that the evidence induce, in the mind of the fact-finder, an actual persuasion that the fact does (or at the relevant time did) exist; 
(2) Where on the whole of the evidence such a feeling of actual persuasion is induced, so that the fact-finder finds that the probabilities of the fact’s existence are greater than the possibilities of its non-existence, the burden of proof on the balance of probabilities may be satisfied; 
(3) Where circumstantial evidence is relied upon, it is not in general necessary that all reasonable hypotheses consistent with the non-existence of a fact, or inconsistent with its existence, be excluded before the fact can be found; and 
(4) A rational choice between competing hypotheses, informed by a sense of actual persuasion in favour of the choice made, will support a finding, on the balance of probabilities, as to the existence of the fact in issue.” (at [55])  
20.	I acknowledge that I need only be satisfied and not comfortably satisfied (El-Chami v DME Engineering Services Pty Limited [2019] NSWWCCPD 35). 
Injury to the left thumb 
21.	The applicant alleges she sustained injury to her left thumb due the nature and conditions of her employment and in the alternative that the condition in the left thumb is consequential or results from the accepted injury to the right thumb. 
22.	In her statement of 19 February 2025 the applicant states that she first began to develop pain in her left thumb in about 2019 as a result of overcompensating for her right thumb. 
23.	The applicant further stated that when her duties changed in 2021 to administering PCR swab tests the pain in both thumbs exacerbated immensely but the right thumb was more painful than the left.  
24.	Dr Tawfik, the applicant’s treating hand surgeon, did not note any left sided symptoms when he examined the applicant on 20 April 2023, however by 11 March 2024 the applicant’s general practitioner (GP) had provided a referral to Dr Tawfik with respect to the left thumb. 
25.	Dr New, orthopaedic surgeon qualified by the applicant, in his report of 6 September 2024, having taken a history of the onset of symptoms, expresses the opinion that the applicant is suffering from a consequential condition in her left thumb due to compensating for right thumb. 
26.	Dr Deshpande’s opinion with respect to the left thumb is equivocal across his reports but in his report of 16 December 2024 he accepts pathology in the left thumb and that it may have been aggravated like the right thumb. 
27.	Further, X-rays of both hands on 11 March 2024 demonstrated very mild degenerative change in the carpometacarpal joint of the thumb.
28.	Dr Gilchrist, the GP, records complaints with respect to both thumbs to support claim for nature and conditions. 
29.	While the applicant asserts the onset of pain began in 2018, I note that when she was examined by Dr Tawfik in April 2023 she did not have any symptoms on examination. 
30.	The applicant subsequently underwent surgery to the right thumb in June 2023 and the more significant onset of left thumb pain is after that time as noted by the referral from the GP to 
Dr Tawfik. 
31.	The applicant may have had an onset of pain in 2018 but it appears to have been of limited significance and at the time she initially saw Dr Tawfik in April 2023 she had no symptoms on the left side. On this basis and in the absence of other evidence prior to this time, I do not accept that the applicant’s employment was the main contributing factor to the development or aggravation injury of which the applicant now complains. 
32.	Having regard to the opinion of Dr New together with the recorded onset of symptoms in the left thumb following the right thumb surgery and the evidence of the applicant that she was undertaking most tasks with her left hand following the surgery, I accept, adopting a common sense test of causation that the condition in the left thumb results from the accepted injury to the right thumb. 
33.	For these reasons, there will be an award for the applicant with respect to consequential condition to the left thumb.  
Injury to the right wrist 
34.	The applicant alleges she sustained an injury to her right wrist either due to the nature and conditions of her employment with the respondent or consequential to the accepted injury to her right thumb. 
35.	The applicant, in her statement of 19 February 2025 states that her injuries were caused by the repetitive nature of her employment duties and that she never had issues with either of hands or fingers before she started working for the respondent. 
36.	The applicant’s statement however does not make any explicit reference with respect to the right wrist. 
37.	Dr New examined the right wrist and recorded the range of motion however does not provide any diagnosis with respect to the right wrist. He does express the opinion that: 
“The body parts which have been impaired as a result of the injury are specifically her bilateral thumbs, noting that she is right hand dominate and has had to use her left hand considerably as she developed pain in her right thumb.”
38.	While Dr New does not address causation, he does provide an assessment of whole person impairment with respect to the wrist. The applicant submitted that it was implicit in the whole person impairment assessment that Dr New considered that the wrist was impaired as a result of the workplace injury. This may be so, but without any explanation from Dr New as to how such a conclusion was reached I am unable to evaluate the basis for it and his report is of no probative value on this issue. I am unable to give it any weight. 
39.	In his report of 16 December 2024, Dr Deshpande notes stiffness in the right wrist but confirms she did not suffer an injury to the right wrist and could only have aggravated the right thumb. 
40.	On 19 April 2023, the applicant underwent an X-ray of the right wrist with the clinical history noting chronic pain in right wrist. These pre-dates the surgery to the right thumb. 
41.	On 16 August 2023 Dr Tawfik records that the applicant has quite a stiff wrist. 
42.	On 30 October 2023 the applicant’s hand therapist, Cate Menzies, reports the applicant is using her thumb/hand in most daily tasks however she experiences aching in her wrist and dorsal thumb after activity which may be secondary to weakness.
43.	The applicant carries on onus in establishing either injury or consequential condition. 
44.	I am not satisfied, given the lack of evidence from the applicant of any complaints with respect to the right wrist and the lack of explanation for his assessment provided by Dr New together with the fact that the complaints seem to develop in 2023 well after the applicant had ceased employment that the applicant has met her onus with respect to injury within the meaning of s 4 of the 1987 Act. That is, I am not satisfied the applicant has met her onus in establishing that her employment was the main contributing factor to the development or aggravation of any condition in the right wrist.   
45.	It is evident from the records of Dr Tawfik and Ms Menzies that by the second half of 2023 there was aching and stiffness in the wrist. I have considered whether the records of 
Ms Menzies provide a causative link, on a commonsense basis, between the injury to the right thumb and subsequent stiffness and weakness in the right wrist. While there is a temporal connection between the complaints to Dr Tawfik and Ms Menzies and the surgery to the right thumb in June 2023 neither Dr Tawfik or Ms Menzies express a concluded opinion, nor am I assisted by Dr New or the evidence of the applicant which does not address the right thumb. Further, the clinical history to the right wrist X-ray in April 2023 prior to the surgery notes a history of chronic right wrist pain. Given the complaints prior to April 2023 I am unable to infer a connection between the right thumb surgery and the onset of pain in the right wrist. 
46.	As such, I am not satisfied the applicant has discharged her onus in establishing a consequential condition to the right wrist. 
47.	As such, there will be an award for the respondent on injury or consequential condition to the right wrist.  
Injury to the left wrist 
48.	Again, the applicant alleges she sustained an injury to her left wrist either due to the nature and conditions of her employment with the respondent or consequential to the accepted injury to her right thumb. 
49.	Repeating as above with respect to the right wrist, the applicant, in her statement of 
19 February 2025 states that her injuries were caused by the repetitive nature of her employment duties and that she never had issues with either of hands or fingers before she started working for the respondent. 
50.	Again, the applicant’s statement however does not make any explicit reference with respect to the left wrist and the Commission is left to essentially guess as to the symptoms in the left wrist, when these are said to have come on, what if any particularly employment duties caused or aggravated the symptoms or how the applicant might have changed the way she worked such that the left wrist was more greatly impacted by her work following the onset of symptoms in her left thumb. 
51.	Dr New, upon who the applicant relies, does not provide any assessment or opinion with respect to the left wrist and does not assist.  
52.	Dr Tawfik did not note any left sided symptoms when he examined the applicant on 
20 April 2023. 
53.	Having regard to the opinion of Dr Tawfik, who is the only doctor to have examined the left side, I am satisfied that as at April 2023 the applicant was not complaining of symptoms in the left wrist. It is not clear from the evidence specifically when the applicant ceased work however she came to surgery to the right thumb and was not working from at least June 2023. In the absence of some specific event in the intervening period (which is not disclosed in the evidence) I cannot accept that the applicant’s employment was the main contributing factor to the development or aggravation of any disease condition in her left wrist.    
54.	I turn now to the allegation of consequential condition to the left wrist. The applicant gives evidence in her statement as to the onset of symptoms in the right and left thumb. She notes that after surgery to the right thumb and due to symptoms in the right side, she was required to use her left hand for most tasks and her left-hand symptoms began to deteriorate, including the development of Dupuytren’s contracture in the left hand in April 2024. She had cortisone injections to the left hand in January 2025 without relief. With respect to ongoing symptoms she states she has ongoing discomfort, pain and stiffness in both hands. 
55.	While the applicant’s statement evidence makes generalised comments with respect to the left hands and in particular the left thumb and the Dupuytren’s contracture, the applicant’s statement evidence makes no specific reference to the left wrist, the specific symptoms she was experiencing, the nature of the duties she was performing and how these effected the left wrist. 
56.	Again, the applicant is not assisted with respect to the left wrist by the qualified opinion of 
Dr New in his report of 6 September 2024. Dr New records no history or complaints with respect to the left wrist and provides no diagnosis or opinion with respect to the left wrist. 
57.	The applicant has also been under the care of her treating hand surgeon Dr John Tawfik since April 2023. When he examined the applicant on 20 April 2023 he conducted a detailed examination and recorded his findings with respect to the right wrist and then recorded the applicant had no symptoms on the left side. Even when he later records symptoms in the left thumb he does not record symptoms in the left wrist.
58.	I am not satisfied that the evidence relied on by the applicant discloses a basis for me to draw a conclusion, on a commonsense basis, between the accepted injury to the right thumb and whatever condition the applicant may be experiencing in her left wrist.  
59.	For these reasons I am not satisfied there is an evidentiary basis for finding of either injury or consequential condition to the left wrist.
60.	There will be an award for the respondent on injury or consequential condition to the left wrist.  
Injury to the left elbow 
61.	Similarly to the left wrist, the applicant does not make any explicit reference in her statement to the left elbow. It is not mentioned in the report of Dr New. 
62.	Having recorded on 20 April 2023 that there were no symptoms on the left side, on 
16 August 2023 Dr Tawfik records that the applicant has developed left elbow lateral epicondylitis (tennis elbow). He does not explain how this has developed or the relationship between the accepted injury to the right thumb and left elbow condition. 
63.	It is clear that the condition developed after the applicant ceased work following the right thumb surgery and there is no basis to conclude that the applicant’s employment was the main contributing factor to the development or aggravation of the condition. 
64.	Further, I am unable to be satisfied, in the absence of evidence from the applicant or an opinion as to causation from Dr Tawfik, that any condition in the left elbow results from the accepted injury to the right thumb. 
65.	The applicant has not discharged her onus with respect to either injury or a secondary condition to the left elbow. 
66.	There will be an award for the respondent on injury or consequential condition to the left elbow.   
Dupuytren contracture 
67.	The applicant states in her statement that five months after surgery to her right thumb she developed Dupuytren contracture which she stated she was told was a complication from the surgery. 
68.	Dr New noted the applicant had Dupuytren’s cords with early contracture in her hands over the middle and ring fingers. 
69.	Dr New noted that she had not recovered from her work-related injuries to both her thumbs and has subsequently developed Dupuytren’s cords in both hands. While Dr New notes that the Dupuytren contracture followed in a temporal sense from the surgery he provides no opinion linking the condition. Further, the Dupuytren contracture has developed bilaterally to the ring and middle finger and the applicant only had surgery to the right thumb. Further, 
Dr New does not provide an impairment assessment of any fingers other than the thumb which would be unusual if he considered they were related.  
70.	Dr Deshpande in his report of 17 June 2024 provided his opinion that: 
“Dupuytren’s contracture is not work related or as a result of hand surgery. It is a genetic condition, runs in families, more common in males, common in people of Northern European descent”
71.	In a further report of 16 December 2024 Dr Deshpande noted that the applicant’s father was Scottish, which I have taken to be a reference to the applicant’s Northern European descent. 
72.	Dr Tawfik, on 25 January 2024 reported: 
“She continues to have the Dupuytren’s cords and early contracture in her right hand affecting the first web space as well as right middle and ring finger in palm. She finds that this impedes her dexterity and function and does not feel she can return to her work duties because of it. The Dupuytren’s contracture has not advanced to a point where I would recommend any surgical intervention.”
73.	Dr Tawfik provides no opinion linking the Dupuytren contracture to her accepted work-related injury. 
74.	Finally, hand specialist Ms Menzies recorded on 30 October 2023 “incidentally, small R palmar Dupuytren nodes have developed since surgery”. I understand this to be saying that the Dupuytren nodes were an incidental finding and not related to the accepted right thumb injury and subsequent surgery. 
75.	I do not doubt that the applicant is experiencing Dupuytren’s contracture in both hands. The difficulty I have is that other than a factual confirmation in the evidence that the condition exists and has developed after she ceased work and had surgery to the right thumb, there is no evidentiary basis to connect the development of the condition to either her employment generally or to the accepted injury to her right thumb and thus to make the findings sought by the applicant. 
76.	The applicant has not discharged her onus either with respect to a primary disease injury or a consequential condition in the form of Dupuytren’s contracture to both hands. 
77.	For these reasons, there will be an award for the respondent on injury or consequential condition to the left and right Dupuytren contracture.   
Incapacity and entitlement to weekly compensation
78.	I have found that the applicant has sustained injury to her right thumb and a consequential injury to her left thumb. 
79.	Section 33 of the 1987 Act provides that: 
“If total or partial incapacity for work results from an injury, the compensation payable by the employer under this Act to the injured worker shall include a weekly payment during the incapacity” 
80.	The applicant’s statement records her ongoing symptoms. She notes that the pain is more consistent in her right thumb “particularly with activities such as doing up my bra and buttons”. She does not feel that her condition has resolved and the pain radiates down her wrists and she wears a brace on her right arm when she feels she needs support. She is unable to drive for long periods due to difficulty griping the steering wheel. 
81.	Dr New did not consider the applicant was fit to perform all the duties required of her in her pre-injury role. He recommended a functional and vocational assessment and an assessment by a hand therapist. He noted: 
“If other administrative or supervisory work can be found for her which is more suitable, she can return to that. The results of the functional and vocational assessment will significantly illustrate whether or not she is able to return to work at Laverty”
82.	Dr Deshpande, in his report of 17 June 2024 expressed the opinion that the applicant could do light duties, such as office work including as a receptionist. In a subsequent report of 
16 December 2024, he noted that the applicant was not fit for her pre-injury duties but could do sedentary work not involving constant use of her hands. 
83.	The certificates of capacity, with the exception of a short period when she was certificate for suitable duties not using her right hand between 23 October 2023 to 20 November 2023 for three hours, two days per week on non-consecutive days, all provide that she has no capacity for work. They cease on 27 April 2024 although there is no suggestion of a change in her symptoms. 
84.	Section 37(1) provides that where a worker has “no current work capacity” they are entitled during the second entitlement period to 80% of their PIAWE. 
85.	Clause 9(2) of Schedule 3 of the 1987 Act provides that a “worker has ‘no current work capacity’ if the worker has a present inability arising from an injury such that the worker is not able to return to work, either in the worker’s pre-injury employment or in suitable employment”. 
86.	Having regard in particular to the opinions of Dr New and Dr Deshpande I am satisfied that the applicant’s injuries to her right and left thumb cause incapacity in that she is unable to do work that she was able to do prior to her injury. 
87.	It is then necessary to consider whether the applicant has capacity for suitable employment. This respondent carries the onus in this regard (at [16] and [25]).
88.	Section 32A defines “suitable employment” as “work for which the worker is currently suited” with regard to be had to the nature of incapacity, the worker’s age, education, skills and work experience, any return to work plan and any rehabilitation services that have been provided. Importantly, regard is not to be had to whether such employment is available, whether the work is of a type or nature that is generally available in the employment market, the nature of the worker’s pre-injury employment or where the worker lives. 
89.	The applicant’s incapacity is significant. She is essentially limited in the use of her hands and she gives evidence that doing up buttons or her bra are difficult. I have inferred from this that any kind of fine work with her hands is not possible for her, particularly her right hand. 
Dr Deshpande, who had seen the applicant most recently went further in saying that she cannot do work that requires the constant use of her hands. Dr New thought she might be able to undertake reception duties however it is difficult to foresee a reception role that does not, in its usual course require the use of a telephone and/or typing at a computer and use of a computer mouse and/or the provision of refreshments to guests. These are all activities that require use on a largely continuous basis of the hands and in particular the thumbs to grip and type. 
90.	Further, the applicant is 64 years of age and approaching retirement age. She has worked, collecting specimens with the respondent, since 1991. That is to say she had no experience in any other kind of work in the last 34 years. 
91.	Despite the suggestion of Dr New, there is no vocational or functional assessment before the Commission which might assist in ascertaining any suitable employment options for the applicant. 
92.	Having regard in particular to the applicant’s age and narrow field of experience over the last 34 years together with the extent of her incapacity to her left and right thumbs, I am not satisfied that an administrative, supervisory or reception type role would be suitable. No other type of role has been identified. 
93.	For these reasons, I am satisfied the applicant has no current work capacity and that the incapacity results from the injuries to her left and right thumbs and in particular the difficulty this presents in gripping, undertaking small hand movements and using her hands more generally, with the thumb being an integral part of the function of the human hand.
94.	The applicant’s PIAWE was agreed at $707 per week as at 1 October 2023 with indexing to be applied from 1 April 2024. 
95.	It follows that the applicant is entitled to an award of weekly compensation as claimed from 18 December 2023 to date and continuing.  
SUMMARY
96.	For the reasons set out above I make the findings and orders set out in the attached certificate of determination.