Evans and Comcare (Compensation)

[2016] AATA 827

Evans and Comcare (Compensation) [2016] AATA 827 (20 October 2016)

Division	GENERAL DIVISION
File Number	2015/4396
Re	Biba Evans
APPLICANT
And	Comcare
RESPONDENT

DECISION

Tribunal	Senior Member T Tavoularis
Date	20 October 2016
Place	Brisbane

The decision under review is affirmed.

..........................[sgd]...............................

Senior Member T Tavoularis

Catchwords

COMPENSATION – Medical Treatment – Therapeutic Relief - previously accepted injury of soft tissue strain to neck – physiotherapy treatment provided for over twenty-six years - compensation for continued physiotherapy ceased – decision under review affirmed.

Legislation

Safety Rehabilitation and Compensation Act (Cth) 1988, ss 4 and 16

Cases

Alamos and Comcare [2014] AATA 629

Holt v Comcare (2007) 94 ALD 576; [2007] FCA 405

Jorgensen and Commonwealth of Australia (1990) 23 ALD 321; [1990] AATA 129

Rope and Comcare [2013] AATA 280

Secondary Materials

Transport Accident Commission and Worksafe Victoria, Clinical Framework for the Delivery of Health Services (June 2012 edition)

REASONS FOR DECISION

Senior Member T Tavoularis

20 October 2016

INTRODUCTION

1. Biba Evans (“the Applicant”) suffered an accepted ‘soft tissue strain to the cervical spine (neck)’ injury on 15 June 1990 (“the accepted condition”).

2. The Applicant wants the Tribunal to review Comcare’s (“the Respondent”) decision of 8 July 2015 that the Applicant was not entitled to ongoing compensation for physiotherapy treatment for her accepted condition.

3. The central issue for determination is whether the Applicant is entitled to compensation for medical treatments, in the form of physiotherapy, pursuant to section 16 of the Safety Rehabilitation and Compensation Act 1988 (“the SRC Act”). I am required to take into account whether the Applicant’s physiotherapy is:

   (a)medical treatment for the purposes of section 16 of the SRC Act;

   (b)sought by the Applicant for the accepted condition; and

   (c)considered reasonable treatment in the circumstances.

4. Absent her accepted condition, the Applicant otherwise presents as a fit, active and capable lady. The original injury giving rise to her accepted condition occurred on 15 June 1990, over twenty-six (26) years ago, while she was lifting a heavy bag as part of her work duties. The Applicant worked as a catering assistant at Qantas Airways at the time of the injury. She eventually resigned from the position on or about September 1995. In that year, this matter initially came before the Tribunal and was resolved by way of redemption for incapacity payments and compensation for medical treatment for the Applicant’s injury.

5. The Respondent has paid for something in the order of 906 sessions of physiotherapy at a cumulative cost of $42,198.53. This sum excludes the additional component of gym membership fees, which were also paid by the Respondent.

6. The Respondent reviewed the matter and made a determination on 3 June 2015, to cease payments for physiotherapy treatments with effect from the previous day, 2 June 2015. The Respondent based its decision to cease the payments on the premise that ongoing physiotherapy treatment was no longer reasonable in the circumstances.

7. On 15 June 2015, the Applicant sought a reconsideration of that decision. On 8 July 2015 the Respondent affirmed its…