McNamara and Comcare (Compensation)

This matter concerned an appeal by an employee, Ms McNamara, against a decision by Comcare to cease funding physiotherapy and massage therapy treatments. The dispute centred on whether these treatments were reasonable medical expenses for Ms McNamara to continue to obtain in relation to her compensable conditions, which included chronic pain syndrome and fibromyalgia. The Administrative Appeals Tribunal (AAT) heard the matter, with Deputy President Sosso presiding.

The AAT was required to determine whether the physiotherapy and massage therapy treatments sought by Ms McNamara were reasonable for her to obtain in the circumstances, pursuant to subsection 16(1) of the relevant legislation. This involved assessing the benefit of the treatments, their long-term effects, their potential to cure or significantly reduce the effects of the injury, whether they maintained the status quo, and their cost. The Tribunal also had to consider whether the treatments were part of a comprehensive plan to proactively treat the employee's injury and whether the reasonableness of the treatment should be assessed in light of the specific circumstances and impact of the injury on the employee.

The Tribunal applied established principles for assessing the reasonableness of medical treatment. It noted that a cost-benefit analysis is often required and that the test of reasonableness is both contextual and temporal, meaning a treatment may be reasonable for a period but become unreasonable due to cost or therapeutic reasons. The Tribunal considered expert medical evidence, including that of Dr Garth Eaton, an Occupational Physician, who diagnosed chronic widespread pain syndrome and persistent severe bilateral shoulder, upper limb, and elbow pain. Dr Eaton recommended continued physiotherapy and massage as considered reasonable, alongside other treatments. However, the Tribunal also noted that some specialists did not accept the diagnosis of fibromyalgia. The Tribunal ultimately found that physiotherapy was not reasonable from 30 January 2017.

The Tribunal affirmed the decisions under review, concluding that Comcare was not liable for physiotherapy expenses from 30 January 2017.