1,291 physio sessions are quite enough, says AAT

06 April 2017

In Oliver and Comcare, Deputy President Gary Humphries, sitting in Canberra, approved Comcare’s approach of phasing out physiotherapy sessions for a former Commonwealth employee with a chronic pain condition.

Ms Oliver had contracted a pain disorder in her arms in 1987 as an Assistant Library Officer at the National Library of Australia.  Her claim for compensation was accepted in 1988, and she was certified as permanently unfit for work and made redundant in October 2000.
Between March 1992 and October 2014, Comcare had paid for some 1,291 physiotherapy treatments.

There was little doubt that, over the years, Ms Oliver had benefited from the treatment, but Comcare decided that, from, the start of 2015, she should move to self-management of her pain.

Ms Oliver had suffered a permanent impairment, which had been accepted by Comcare, some years previously.  She argued that, in circumstances where Comcare had accepted that she had a permanent impairment, it could not then decide that ongoing treatment was inappropriate.  The Tribunal dismissed that particular argument, saying that treatment always had to be looked at to see if it was reasonable.

Ms Oliver was able to convince the Tribunal that she did have an ongoing pain condition (Comcare had argued that it had been supplanted by a constitutional fibromyalgia condition), and evidence provided by Professor Champion helped in that regard.

However, even Professor Champion did not agree that physiotherapy was always appropriate treatment for managing a pain condition.

In deciding the issue, the Tribunal had regard to the Clinical Framework for the Delivery of Health Services (the Framework).  Under the Framework, the Tribunal considered:

  1. The long-term effect of the treatment, and its benefit to the worker.
  2. Whether the treatment is likely to cure the injury or significantly reduce its effects.
  3. The cost of ongoing treatment.

The Tribunal was swayed by Professor Champion’s view that ‘pain medicine guidelines are not supportive of resuming physiotherapy’ after such a long period of treatment  The Tribunal found that ‘a sustained but open-ended program of physiotherapy over nearly 30 years has made Ms Oliver dependent on it and discouraged the exploration of less costly alternatives, particularly self managed ones.’

Accordingly, the Tribunal went on to find that Ms Oliver’s physiotherapy did not constitute treatment that it was reasonable for her to obtain in the circumstances, and the Tribunal affirmed Comcare’s decision to cease paying for physiotherapy sessions beyond the start of January 2015.

This is another example of Comcare taking a more pro-active approach – especially in relation to ceasing passive therapies for intractable (or permanent) pain conditions.

This article was written by Andrew Allan, Partner.

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