A reasonable lifestyle?

04 October 2019

The Administrative Appeals Tribunal has recently handed down the decisions of Reece v Comcare [2019] AATA 3499 and ZXCF v Comcare [2019] AATA 3572, concerning reasonableness of the use of unconventional medical treatment for compensable injuries pursuant to section 16 of the Safety, Rehabilitation and Compensation Act 1988 (‘SRC Act‘).

ZXCF v Comcare [2019] AATA 3572 (17 September 2019)

Background

The Applicant, in the employ of the Department of Social Services until 16 July 1993, has an accepted claim for post-traumatic stress disorder. The Applicant sought compensation for nutritional supplements (zinc, magnesium powder, B12, methyl folate, B6, vitamin C and CoQ10) and craniosacral therapy (soft touching of the head), in relation to her compensable condition. Liability was denied and the matter proceeded to hearing.

The fundamental question to be determined was whether the Respondent was liable to pay compensation for these alternative therapies pursuant to section 16 of the SRC Act.

AAT Decision

In determining the matter, Senior Member Dr Evans considered the Applicant’s reasons for requesting nutritional supplements and craniosacral therapy. It was noted that the Applicant, being unable to tolerate anti-depressants, believed that using ‘alternative therapies‘ have allowed her to ‘rise from being bed ridden to being able to function reasonably well.‘ This belief was supported by the evidence of her treating practitioner, who considered that the Applicant ‘found considerable relief‘ and ‘improvement in her symptoms‘ from the requested treatments.

Dr Evans considered the nutritional supplements and craniosacral therapy were ‘therapeutic treatment’ within the meaning of section 4(1) of the SRC Act as they are ‘given for the purpose of alleviating‘ symptoms of the compensable condition, at the direction of her treating practitioner.

Ultimately, Dr Evans found that, as the Applicant was intolerant of anti-depressant medication, it would be unreasonable to discontinue the alternative treatments, in circumstances where they gave the Applicant the best chance to manage her symptoms, allowing her to function in her day-to-day life.

It was therefore held that the nutritional supplements and craniosacral therapy were reasonable for the Applicant to obtain the circumstances.

Dr Evans noted that his conclusions were not intended to create a precedent that alternative therapies are generally compensable. Rather, it will depend on a range of factors specific to the facts, circumstances and medical evidence in each matter.

Reece v Comcare [2019] AATA 3499 (16 September 2019)

Background

The Applicant had a compensable low back injury of 30 March 1982 resulting in left foot symptoms, for which he claimed Brooks Dyad Walker (orthotic) shoes and Orthaheel (Ease) thongs (cushioned thongs). The Respondent, although having previously accepted liability for orthotics, rejected liability for the requested footwear.

The Respondent subsequently conceded liability to pay compensation for the Brooks Dyad Walker shoes, as they housed the Applicant’s orthotics. The dispute before the Tribunal was whether the Respondent was liable to pay compensation in respect of cushioned thongs.

AAT Decision 

Member Maryniak considered that the Applicant’s thongs were not the same as the accepted shoes housing the Applicant’s prescribed orthotics, noting that thongs, whilst comfortable, were not ‘inextricably linked‘ to the orthotics or the compensable condition.

Member Maryniak referred to the opinion of the Applicant’s treating podiatrist, that the purpose of the thongs was to avoid the risk of further and distinct injury – as opposed to the alleviation of symptoms in the left foot. For these reasons, it was concluded that the claimed thongs were not ‘medical treatment’ for the purposes of the SRC Act, being distinct from the accepted footwear housing the Applicant’s orthotics.

Discussion  

Comparison of the decisions of ZXCF and Reece highlight the differing factors to be considered when assessing claims for medical treatment or aids pursuant to section 16 of the SRC Act.

Though both matters are factually diverse, the fundamental question is whether the claimed unconventional treatment falls within the definition of medical treatment in section 4(1) of the SRC Act (in particular, being ‘therapeutic treatment’ at the direction of a treating medical practitioner or under the supervision of a health provider) and whether it is reasonable in the circumstances for the purposes of section 16 of the SRC Act. In addressing these questions, the cases turn on whether the evidence establishes that the treatment requested will alleviate the symptoms of the employee’s compensable condition.

Although Dr Evans did not intend for the decision in ZXCF to be considered a precedent with respect to alternative therapies, it certainly highlights the significance of these therapies being recommended by treating practitioners if they improve (or are thought to improve) the effects of compensable conditions in day to day living. In contrast, Reece serves to limit the bounds by requiring the claimed treatment to be inextricably connected to the compensable condition.

This article was written by Tim Ainsworth, Partner and Tarana Singh, Associate.


For further information, please contact any member of our National Comcare Claims group:

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