George Stacey and Comcare - [2015] AATA 386

[2015] AATA 386

Division GENERAL ADMINISTRATIVE DIVISION

File Number(s)

2014/1600

Re

George Stacey

APPLICANT

And

Comcare

RESPONDENT

DECISION

Tribunal
Deputy President Gary Humphries

Date 2 June 2015

Place Canberra
The decision under review is affirmed.
........................[sgd]................................................
Gary Humphries
Catchwords
COMPENSATION – Commonwealth employee – applicant suffered stroke at work – whether costs of medical treatment in relation to injury suffered at work – medical treatment prescribed for purposes other than treatment of stroke – decision under review affirmed.
Legislation
Safety Rehabilitation and Compensation Act 1988 (Cth)
Cases
Abrahams v Comcare (2006) 93 ALD 147
Dunkerley and Comcare [2014] AATA 381
Dunkerley v Comcare [2015] FCA 392
Pratt and Comcare [2004] AATA 1281
Telstra Corporation Ltd v Hannaford (2006) 151 FCR 253
Secondary Materials
Commonwealth, Parliamentary Debates, House of Representatives, 27 April 1988, 2191 (Brian Howe)
REASONS FOR DECISION
Decision under review

This decision under review is a decision of Comcare dated 12 March 2014 (affirming a determination dated 2 January 2014) that Comcare was not liable to pay compensation to Mr Stacey under s 16 of the Safety, Rehabilitation and Compensation Act 1988 (the Act) for the costs of two pharmaceuticals (Anagrelide and Asasantin) and of medical reviews by his treating haematologist.
At the outset of the hearing Mr Stacey indicated that a related application (2014/1599) need not be considered by the Tribunal because it related to superficial wound dressings for an ulcer on his right ankle. This ulcer had cleared up and he no longer required these dressings. The Tribunal dismissed this application by consent.
The hearing proceeded on the basis that Mr Stacey sought compensation for a third pharmaceutical, Pravachol. On later examination, it became evident that neither of the two reviewable decisions by the respondent in relation to Mr Stacey's claims had dealt with this drug, and as a result the Tribunal probably had no jurisdiction to make a fresh decision in relation to it. However, for the sake of completeness I will include reference to it in these reasons, in that I found that the fate of a claim for this drug would have been the same as for the other two drugs.
Background
On 15 September 2003, Mr Stacey had the misfortune to suffer a stroke while at work at the Australian Taxation Office. He spent some time in hospital after this incident, and needed extensive rehabilitation to restore some measure of normalcy to his life. Even so, the effects of the stroke remain with him today. He walks with a limp. He has pins and needles down his left side, and his left leg and arm are always cold. He sometimes suffers severe sciatic pain, and muscles on the right side of his body also experience pain as they compensate for the weakness of other muscles.
Unsurprisingly in these circumstances, Mr Stacey gave up work in 2004. Comcare accepted liability for "unspecified cerebrovascular disease" (in effect, a stroke), and for 10 or so years following the incident was meeting a range of Mr Stacey's…

Grounds of appeal

[14] The appellant contends that the primary judge erred in finding that the respondent had discharged the onus of establishing the matters required under the relevant provision.

[15] It was submitted that his Honour failed to give adequate weight to the evidence of the second witness, and that the findings of fact were not reasonably open on the material before the Court.

[16] The respondent, for its part, submits that no error is disclosed, and that the conclusions reached were well within the range of outcomes available to the primary judge.

Consideration

[17] It is convenient to deal first with the question of construction, as the resolution of that issue informs the remaining grounds advanced by the appellant.

[18] For the reasons that follow, we are of the view that the appeal should be allowed in part and the matter remitted for further determination.

Continue reading George Stacey and Comcare

Details

AGLC: George Stacey and Comcare [2015] AATA 386
Case: [2015] AATA 386
Decision Date: 2 June 2015

CaseChat Overview and Summary

The applicant, Mr George Stacey, sought compensation from Comcare for the cost of medical treatment related to a stroke he suffered at work. The matter was heard by the Administrative Appeals Tribunal, with Mr Stacey arguing that the costs of his medical treatment were compensable under the relevant legislation. The central legal issue was whether the costs of treatment for Mr Stacey's ongoing medical conditions, which were not directly caused by the stroke but were exacerbated by it, were compensable under the Safety, Rehabilitation and Compensation Act 1988.

The Tribunal found that the costs of the medical treatments in question were not related to the treatment of the stroke itself but rather to Mr Stacey's pre-existing condition of essential thrombocythaemia. While the Tribunal acknowledged the impact of the stroke on Mr Stacey's life and the need for continued medical treatment, it concluded that the costs of treatment for conditions not directly resulting from the stroke were not compensable. The Tribunal upheld the decisions of Comcare to discontinue payments for certain treatments, including Anagrelide, Asasantin, Pravachol, wound dressings, and visits to the haematologist.

In affirming the decisions of Comcare, the Tribunal emphasized that the legislation requires a direct link between the compensable injury and the costs of the treatment in question. Since the treatments were not prescribed specifically for the stroke, but rather for the management of thrombocythaemia, the Tribunal found that Comcare was not liable for these costs. The Tribunal's decision was based on the lack of a direct causal connection between the stroke and the treatments in dispute.

The Tribunal's decision was upheld, and the determinations made by Comcare were affirmed. Mr Stacey's claim for compensation for the costs of the specified medical treatments was dismissed.

Orders

Orders of the court

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Background

Background to the litigation

The hearing proceeded on the basis that Mr Stacey sought compensation for a third pharmaceutical, Pravachol. On later examination, it became evident that neither of the two reviewable decisions by the respondent in relation to Mr Stacey's claims had dealt with this drug, and as a result the Tribunal probably had no jurisdiction to make a fresh decision in relation to it. However, for the sake of completeness I will include reference to it in these reasons, in that I found that the fate of a claim for this drug would have been the same as for the other two drugs.Background On 15 September 2003, Mr Stacey had the misfortune to suffer a stroke while at work at the Australian Taxation Office. He spent some time in hospital after this incident, and needed extensive rehabilitation to restore some measure of normalcy to his life. Even so, the effects of the stroke remain with him today. He walks with a limp. He has pins and needles down his left side, and his left leg and arm are always cold. He sometimes suffers severe sciatic pain, and muscles on the right side of his body also experience pain as they compensate for the weakness of other muscles. Unsurprisingly in these circumstances, Mr Stacey gave up work in 2004. Comcare accepted liability for "unspecified cerebrovascular disease" (in effect, a stroke), and for 10 or so years following the incident was meeting a range of Mr Stacey's medical and pharmaceutical costs. However, in early 2014, Comcare discontinued payments in respect of Anagrelide, Asasantin and Pravachol, for the wound dressings, and for visits to the haematologist, on the basis that these treatments were not related to Mr Stacey's compensable condition. Determinations were made to that effect in January 2014. He sought reconsideration of both determinations but they were affirmed on 12 March 2014. Other costs, such as those related to his visits to Dr Shroot, his GP, have continued to be met by Comcare.The medical history Mr Stacey was diagnosed in 1999 as suffering from a form of myeloproliferative disorder, more specifically essential thrombocythaemia. An effect of this condition is to elevate the platelet count in the bloodstream. With this condition the platelets also become more “adhesive”, adding to the chance that they will contribute to a stroke. He was being treated for the thrombocythaemia from no later than 2002 by taking Hydroxyurea, which provided some relief of his condition but had the unfortunate side-effect of causing a painful ulcer on his right ankle. Both doctors giving evidence at the hearing speculated that the thrombocythaemia was a probable contributor to the stroke he suffered in 2003. Certainly soon after the stroke Mr Stacey began to be prescribed drugs which it appears were intended to alleviate the symptoms of thrombocythaemia: Asasantin from November 2003 and Pravachol from January 2004. He could not recall when he began to take Anagrelide but Dr Shroot’s records suggest he was prescribed this by the middle of 2009 at the latest.

Evidence

Evidence Before The Court

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Decision

Reasons for decision

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Ratio Decidendi

Legal Principle Established

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Division	GENERAL ADMINISTRATIVE DIVISION
File Number(s)	2014/1600
Re	George Stacey
APPLICANT
And	Comcare
RESPONDENT

Tribunal	Deputy President Gary Humphries
Date	2 June 2015
Place	Canberra