Church and Comcare (Compensation)

This matter concerned an appeal by an applicant against a decision by Comcare regarding the provision of medical expenses for an injury sustained in 1986. The applicant sought compensation for chiropractic treatment, arguing that it alleviated her pain. Comcare had previously accepted liability for the original injury, which involved a lumbar disc prolapse, but disputed the ongoing entitlement to medical expenses for the chiropractic treatment.

The central legal issue before the Tribunal was whether the applicant was presently entitled to payment for chiropractic treatment, given that the original injury was no longer considered to be the cause of her current symptoms and that the treatment regime was not considered to be active, sustainable, or cost-effective. The Tribunal was required to determine the reasonableness of the requested medical expenses in light of evolving medical understanding and established principles for assessing the appropriateness of treatment.

The Tribunal acknowledged that the applicant's treatment had been predicated on the belief of a prolapsed disc, but concluded that the correct original diagnosis should have been non-specific lower back pain. It noted that while the chiropractic treatment provided temporary relief, it did not offer substantial or measurable benefits, nor did it promote active patient involvement or self-management, which are key principles of the Clinical Framework for the Delivery of Health Services. Applying the tests of reasonableness, the Tribunal found that the current treatment regime was not consistent with modern medical practice, was not of limited duration, and was not financially cost-effective, thus not a justifiable expenditure of public funds.

Despite affirming the decision under review, the Tribunal recommended that Comcare consider waiving any debt arising from its administrative error in continuing to pay for treatments after explicitly stating it would not do so.