Pedder and Military Rehabilitation and Compensation Commission
[2008] AATA 290
•10 April 2008
Administrative Appeals Tribunal
DECISION AND REASONS FOR DECISION [2008] AATA 290
ADMINISTRATIVE APPEALS TRIBUNAL ) N° V 200600934
)
VETERANS’ APPEALS DIVISION ) Re JOHN FREDERICK PEDDER Applicant
And
MILITARY REHABILITATION AND COMPENSATION COMMISSION
Respondent
DECISION
Tribunal Dr R. McRae, Member Date10 April 2008
PlaceMelbourne
Decision
The Tribunal affirms the decision under review.
Roderick McRae
Member
MILITARY COMPENSATION ‑ claim for travel expenses
Compensation (Commonwealth Government Employees) Act 1971
Safety, Rehabilitation and Compensation Act 1988 ss 16(1), (6), (7), (8)
Re Corfield and Australian Postal Corporation [2000] AATA 533
Re Reilly and Military Rehabilitation and Compensation Commission [2007] AATA 1826
Re Stevens and Comcare (AAT 10498, 26 October 1995)
REASONS FOR DECISION
10 April 2008 Dr R. McRae, Member 1. Mr John Pedder (the Applicant) injured his back while serving in the Australian Army in the 1960s. He claimed compensation and was ultimately successful. However, the Military Rehabilitation and Compensation Commission (MRCC) (the Respondent) rejected the Applicant’s claim for reimbursement of travel expenses to attend medical consultations with Dr Helen Kouzmin in North Carlton. The Applicant seeks a review of this decision by the Tribunal.
2. The issue for the Tribunal is whether the Applicant is entitled to travel expense reimbursement by the MRCC under s 16 of the Safety, Rehabilitation and Compensation Act 1988 (the Act) for consultations with Dr Kouzmin for the condition of aggravation of developmental lumbar scoliosis with mild diffuse lumbar disc degeneration and referred pain to lower limbs. The Tribunal’s decision is that the Respondent is not liable to reimburse the Applicant.
3. The Applicant was represented by Returned Services League (RSL) Senior Advocate, Mr B. Turner. The Respondent was represented by Mr J. Wallace of counsel, instructed by the Australian Government Solicitor. The Tribunal had before it documents lodged by the Respondent under s 37 of the Administrative Appeals Tribunal Act 1975 (the T-documents).
4. The Tribunal received additional documents tendered into evidence by the Applicant:
·A hand-written one page letter on Dr Kouzmin’s letterhead dated 12 April 2007, written and signed by Dr Kouzmin (Exhibit A1);
·23 pages of the Applicant’s Medicare file, with the run date of 14 August 2007 for the period from 1 June 1998 to 24 July 2007 (Exhibit A2); and
·The decision of the Administrative Appeals Tribunal in Re Reilly and Military Rehabilitation and Compensation Commission [2007] AATA 1826 (Exhibit A3).
5. The Tribunal received the additional documents tendered into evidence by the Respondent
·The Respondent’s Statement of Facts and Contentions (Exhibit R1); and
·Decision of the Medical Practitioners Board of Victoria (MPBV) in Re: Dr Helen Kouzmin [2006] MPBV 11 (Exhibit R2).
BACKGROUND
6. The Applicant is a 61 year old man who served in the Australian Army until 7 March 1967. He receives a service pension and is an RSL Trustee. He resides in Werribee South, having previously lived in Yarra Junction for some seven years, and in Launching Place prior to that.
7. The following summary is assisted by that provided by the Respondent. The Applicant has received this information and has not commented upon it. The Applicant made no reference to this background information in his Statement of Facts and Contentions, nor in submissions to the Tribunal. The Tribunal understands that the facts are not in dispute.
8. On 5 March 1979 the Applicant lodged a claim for compensation, supported by a statutory declaration, relating to a severe back injury during the course of service on 22 October 1965 (T4). This claim was rejected on 20 March 1980. On 30 June 1982, the Administrative Appeals Tribunal (AAT) determined that the Applicant suffered a personal injury and the employer was liable to pay compensation to him for the injury in accordance with the provisions of the Compensation (Commonwealth Government Employees) Act1971 (T5). On 25 October 1982 the AAT determined the Applicant was totally incapacitated (T5). Compensation payments were awarded from 11 December 1979 (T5). On 1 June 1990 the Applicant received written advice that from 5 July 1990, the Department of Defence would no longer be liable to pay compensation (T7). On 12 September 1994 a claim for impotence was disallowed on the basis of no link between the claim and the compensable back condition (T8). The Applicant claimed a lump sum payment for aggravation of developmental lumbar scoliosis with mild diffuse lumbar disc degeneration which was rejected by letter dated 27 October 1997(T10).
9. In a letter dated 28 May 1998 (T13) the Respondent advised the Applicant that it considered the high number of kilometres driven by the Applicant to receive medical treatment was not reasonable, and that it considered suitable medical practitioners were present in the Applicant’s local area. A similar letter was written to the treating orthopaedic surgeon (T11).
10. A record of conversation between the Applicant and Mr Hartley Beer, an employee of the Military Compensation and Rehabilitation Service, on 8 July 1998 (T15), includes the Applicant stating that there was no provider of authorised treatment within 50 kilometres of his home and that he relied heavily on travel reimbursement as an income supplement.
11. On 16 July 1998 the Respondent determined what medical treatment and expenses it would authorise, relying on the decision in Re Stevens and Comcare (AAT 10498, 26 October 1995).
12. A medical report dated 2 February 1999 prepared by Dr Kouzmin (T27), medical practitioner, with rooms in North Carlton, stated the Applicant had been referred to her for assessment by Dr Malcolm Hooper, the Applicant’s treating chiropractor, in October 1998. In a letter dated 22 January 2003 (T30) Dr Kouzmin stated the Applicant was referred to her by Dr Peter White, his treating local general practitioner, and was also referred by Dr Hooper. She diagnosed advanced cervical and lumbar spondylosis with neurological complications, and prescribed medication, physical therapy and hyperbaric oxygen. In a medical report dated 20 July 1999, she requested authorisation for past and ongoing costs of various medications related to the treatment of the Applicant’s back, impotence and gastro-oesophageal symptoms, for ongoing physiotherapy and hydrotherapy.
13. On 10 September 1999 the Respondent varied the determination dated 16 July 1998, to accept liability for a back brace and various medications. The Respondent denied liability for medical expenses in relation to impotence, gastro-oesophageal condition and psychological conditions but affirmed the decision in all other respects (T23).
14. On 18 February 2002 the Respondent extended liability to include referred pain to the lower limbs (T26).
15. On 18 December 2002 the Applicant’s solicitors wrote a letter requesting reimbursement of the Applicant’s travelling expenses in relation to consultations with Drs Kouzmin and McCarthy (T28).
16. On 24 January 2003 the Respondent replied to the Applicant’s solicitors reiterating its previous determination of 13 (sic) July 1999 and decision of 13 (sic) September 1999 (T31). The letter noted the Applicant had not provided evidence that he required exclusive treatment that only Dr Kouzmin could provide. He had also not advised the Respondent of the nature or extent of treatment provided. He had not sought review of the decision by the AAT. The Respondent concluded that it was unable to approve payment of any travelling or medical expenses.
17. In a letter dated 5 February 2003, Dr White stated that he had referred the Applicant to Dr Kouzmin in 1999 in her capacity as a rheumatologist for treatment of his degenerative disease of the Cervical and Thoraco-lumbar spine (T32).
18. In a letter dated 11 February 2003, the Applicant stated he could not find any Repatriation hospital in Werribee or other areas. He stated that he had not been advised that travel allowances had ceased (T33).
19. On 17 February 2003 the Respondent sent another copy of its 24 January 2003 letter (T35). The Respondent requested the Applicant forward the requested information as it was unable to process any expenses without that information.
20. In a letter dated 11 March 2003, Dr White stated he was unable to locate the original referral letter to Dr Kouzmin (T36). He stated he recalled that although Dr Kouzmin was a long distance away from the patient … I felt that Dr Kouzmin was in the best situation to treat the patient’s particular problems.
21. A letter dated 13 August 2004 from Dr Kouzmin provided a list of dates on which the Applicant had attended her rooms.
22. The Applicant submitted a travel expense claim dated 10 August 2004 to the Respondent (T45). On 9 September 2004 the Respondent determined it was liable to pay compensation related to the Applicant’s travelling expenses in the amount of $37.41, representing 79.6 kilometres for the period, at the gazetted rate of 47 cents per kilometre (T47). The Respondent determined the Applicant was not entitled to claims for travel expenses for his appointments with Dr Kouzmin and included a copy of the previous determination dated 16 July 1998.
23. The Applicant requested reconsideration of this determination on 17 September 2004. On 8 October 2004 Dr Kouzmin stated that the Applicant was originally referred to her by Drs White and Hooper because there was no one in Mr Pedder’s area who had the knowledge and experience to cope with the investigation and management of his multiple medical problems (emphasis added).
24. In a medical report dated 26 November 2004 (T 53) Dr Kouzmin stated she had treated the Applicant for six years and had taken a great deal of trouble to assist him in respect of his back condition and other medical problems. She stated that to her knowledge a patient in Australia has the right to continue to see the specialist to whom he was originally referred irrespective of their geographical location of the specialist in a given city …
25. In a medical report dated 22 December 2004 (T56) Dr Kouzmin stated the Applicant had been referred to her as a general physician with 20 years experience, by Dr White in Yarra Junction, where the Applicant had previously resided. She noted the Applicant’s previous treating surgeons had retired. She stated the Respondent had accepted her management of the Applicant’s claims from the start. She stated I don’t need to look in the phone book for physicians closer to him. He was referred to me and there is nothing more to say …
26. On 4 February 2005 the Respondent affirmed the determination of 9 September 2004 (T57). This is the decision under review by the Tribunal.
APPLICANT’S EVIDENCE
27. The Applicant stated that he first met Dr Kouzmin in late 1997 in relation to his lower back and spinal conditions. He also had received treatment for pneumonia. In answer to the question: Did you discuss anything else?, the Applicant replied Yes, she gives me confidence. He described the doctor/patient relationship he had with Dr Kouzmin as she gives me full confidence within myself; I see this as a great thing. He stated he had tried to locate a general physician closer to his home, and there were none. The Respondent had never provided him with a list of general physicians closer to his home.
28. Under cross-examination the Applicant agreed he had widespread degenerative changes in his neck and lower back conditions. He agreed his left leg problem was associated with his back problem, and Mr Michael Johnson had arranged for him to have a magnetic resonance image (MRI) on 10 November 2007. He was also receiving management by Mr Ryan, neurosurgeon. Dr Kouzmin had referred him to Mr Johnson.
29. The Applicant stated that he drove his own car to his appointments with Dr Kouzmin. He said it took about 35 minutes from Werribee South to North Carlton. He had to stop and get out of his vehicle during the drive due to a stiff and painful back and left lower limb to the great toe. He possesses an unrestricted driver’s licence. Public transport access was difficult between the two addresses. While he lived in Launching Place in 1998 he consulted with Dr Kouzmin about once per month, increasing to fortnightly if he had severe symptoms. His left leg symptoms appeared in early 2000.
30. The Applicant was aware there were groups of general practitioners in Werribee, some 11 kilometres from his home. He has accessed them if he has required a prescription. They have communicated with Dr Kouzmin.
31. The Applicant agreed Dr Kouzmin dealt with many of his conditions including pneumonia, stress, obstructive sleep apnoea (OSA), erectile dysfunction and many other medical problems. He specifically agreed that Dr Kouzmin treated more than pneumonia and his back. She treated me when I get sick, not just military. When asked if he considered Dr Kouzmin to be his general practitioner, he stated Dr White referred me to Dr Kouzmin; Dr Kouzmin refers me to other doctors. The Applicant stated that Dr Kouzmin had helped him with marital problems. She supported him for all his medical and emotional problems. She had arranged a brain MRI in 2000, the result of which was normal. He has not paid her for any consultation.
32. The Applicant agreed he had X-rays and an MRI in 1996 prior to his referral to Dr Kouzmin. He agreed that it is not correct that only Dr Kouzmin diagnosed his back condition. He agreed that after referral to Dr Kouzmin, he developed symptoms of neck pain, and that she undertook imaging once he reported the symptoms.
33. The Applicant stated he had not considered looking for treatment with any medical practitioner other than Dr Kouzmin. He considered Dr Kouzmin to be his treating doctor. She had treated him since late 1997; he had complete confidence in her; she helps with his stress. He had not consulted a psychiatrist. Dr Kouzmin had not stated she was a psychiatrist. He did not consider that it would be useful to see a doctor closer to his home, despite the cost and pain associated with travel to North Carlton. He had confidence in Dr Kouzmin, and had been referred to her by another doctor. He believed that if you have been referred, then you don’t object. He had good faith with Dr Kouzmin, so why … look for someone else? He agreed he insisted on seeing Dr Kouzmin when he could have seen another doctor anywhere, but they all talk with Dr Kouzmin. He was not aware of Dr Kouzmin’s qualifications: she is a medical practitioner, who teaches someone to become a doctor. She is a person who examines thoroughly and refers to other doctors. He did not know if she was a specialist. He acknowledged that he was not forced to see Dr Kouzmin. He did not know what he would do if Dr Kouzmin moved interstate or retired from practice.
34. The Applicant was aware of correspondence about his travel allowance. He was aware of the presence of the Werribee Mercy Public Hospital near his home, as he drove past it frequently. He had had a Computerised Tomography scan performed there and received treatment for OSA. He was unaware of hospitals being listed in his Melways street directory. He had not considered if he could undertake his medical care more easily in his local area. He was not aware of any specialists located between his residence and Dr Kouzmin’s rooms. He had not asked the RSL if there were any doctors closer to him than Dr Kouzmin. He has MCRS-funded visits to a local chiropractor twice a week. He conceded that there was a difference between a choice of doctor as opposed to funding to visit a chosen doctor.
35. The Applicant recalled the telephone conversation with Mr Beer (T15). He denied that he relied on the travel allowance as an income supplement. He required it to cover fuel costs. He insisted he had moved from Launching Place to Werribee South to be closer to Dr Kouzmin. He did not want to live in Carlton. He had grown up in Altona, and said he knew people in Werribee.
DR KOUZMIN’S EVIDENCE
36. Dr Kouzmin gave evidence by telephone from her consulting rooms at the Rathdowne Village Medical Centre. She was convalescing from a major medical procedure. She stated her occupation was physician and general practitioner. She said the differences between the two related to the training, knowledge and experience, and examinations undertaken. She possesses no particular physician sub-specialty qualification.
37. The Applicant had been her patient for some 10 years, originally referred by a chiropractor related to his back problems. She had identified areas affecting his health and overcome a lot of problems, and referred him to other specialists. She had coordinated visits and future back surgery if required, and considered herself as the coordinator of his management of a number of medical conditions. She considered the confidence and trust in [her] was important in the treatment and rehabilitation of [the Applicant] so he would follow advice.
38. Dr Kouzmin considered the Applicant had slight mental retardation and child-like attitudes. She was aware that he always had a slightly simplified view of things, and was unable to cope with a cynical view of life. He is just a simple person who means what he says. She was uncertain if this is why he developed a bond with her. She had been kind to him. It would have been hard to dissolve the relationship without any explanation; she did not think he would understand. She was aware of the issue of the distance between his home and the practice, but had preserved the relationship. She considered that the complexity of the Applicant’s medical condition was best managed by a physician rather than a general practitioner. She stated a general practitioner probably wouldn’t examine him and find his [neurological] signs. He also had serious lung problems and a sleep disorder, asthma, prostate, and impotence. He was a typical physician patient seen in a clinic of a major hospital. His back was the major relevance to his military service.
39. Dr Kouzmin was not aware of the services available at Werribee Hospital. She was certain that in a hospital surgery he wouldn’t have the same doctor: he would have been left to a resident or registrar. There was no guarantee that he would have seen a specialist. Her training in psychiatry was a component of her physician training. She had a lot of experience in psychiatry, and had been asked to give evidence in the Voyager trials in relation to P[ost] T[raumatic] S[tress] D[isorder].
40. Under cross-examination Dr Kouzmin stated there are no records of the original referral from Dr Hooper, but she recalled the time was late 1998 and it related to back pain. She agreed that after some time the neck pain developed, causing her to undertake X-ray and MRI imaging.
41. Dr Kouzmin was uncertain if the Applicant was dependent on her. There was no doubt he has full confidence [in me]. [I am] unsure [regarding] dependence. He sees other doctors when necessary. Her management of his spine was with pain-killers, anti-inflammatories and surveillance. She agreed this was the type of management he could obtain from any general practitioner in Victoria. If the Applicant attended the Werribee Medical Centre, she would deal with a doctor there from time to time. She agreed the doctors there were competent to deal with what she did for his spinal problems. She agreed that he had many medical problems which fell within her physician training expertise which had nothing to do with his military service, and this was why he visited her. She agreed that the pain he experienced as he travelled to see her was not good for him. She would have written to another physician nearer to the Applicant’s home if she had been able to identify one. She was not aware of any physicians in the Werribee area as she had not looked. In reply to the question: Do you have the view of yourself that you alone can provide medical care to the Applicant? She answered: He wanted to see me and I do my best; I know what happens in public hospitals. She hoped she did not have too great a sense of personal responsibility for the Applicant, and she aims to avoid this.
42. Dr Kouzmin agreed she was the subject of a review by the Medical Practitioners Board of Victoria (MPBV) in June 2006. She agreed she informed the board that she gets a huge sense of personal responsibility for her patients. She considers it is better to have some than none. If you are implying that it is pathological, I don’t think so. She agreed at the hearing that she had admitted to the MPBV she discounted experts’ opinions. She agreed she was found guilty of unprofessional conduct not of a serious nature (as part of that decision), which included an element of a loss of objectivity of the doctor/patient relationship.
43. She agreed she had advised the MPBV that her practice consisted of 10 per cent Specialist, 20 per cent referral for medico-legal work and 70 per cent G[eneral] P[ractice]. She agreed that she is now largely a general practitioner, but she is able to deal with complex medical cases which include conditions that are hard to diagnose. She receives Australian Doctor, a publication for general practitioners. She stated she is not a rheumatologist, rather a generalist [physician]. She agreed that there is no linkage between OSA and spinal problems. She agreed there was no medical reason that the medical relationship with the Applicant had to be maintained. She had not been able to find the strength to say [to the Applicant] you have to see someone else as he wouldn’t understand.
44. She is uncertain if she will return to work due to her health status, and it is inevitable the Applicant will have to see another doctor sometime in the future. She did not think she would try to find another physician for him, just a reasonable doctor. She would not refer him to a psychiatrist as his type of problems apart from mild depression is difficult to categorise. The psychiatrist he has seen has misinterpreted his childlike state as stupid behaviour. She had not communicated with this psychiatrist, but had seen the files. She was not concerned about the Applicant’s psychiatric state. She disagreed that she was not prepared to let go and that she disagreed with experts in the [medical] field [under consideration for a particular problem].
Applicant’s Submissions
45. Travel allowance was paid for the Applicant to attend Dr Kouzmin while he resided in Launching Place. There has been a long-standing medical relationship between the Applicant and Dr Kouzmin. The Applicant has complex medical problems that are best managed by Dr Kouzmin. It is in the Applicant’s interests that the bond should be preserved. While another physician could treat the Applicant, the therapeutic relationship may not be there. Thus the claim for compensation for travel expenses to attend Dr Kouzmin should be allowed. The Applicant relies on the decision in Reilly v Military Rehabilitation and Compensation Commission [2007] AATA 1826, in which the bond between Ms Reilly and her treating psychiatrist was essential to her well-being, and while the distance travelled was greater than 50 kilometres, it was deemed necessary to preserve the bond.
Respondent’s Submissions
46. The respondent distinguished this matter from Reilly as that psychiatrist had a long experience with the type of condition being treated, and was a sub-specialist in the specialist area of psychiatry. That doctor/patient relationship would have been essentially irreplaceable and the cessation of the relationship detrimental to the patient in its own right, and the relationship was a substantial component of the therapy itself. The Applicant could have been adequately managed by any number of doctors with appropriate specialist referral as required. Dr Kouzmin was genuinely attempting to treat the Applicant holistically, but had difficulty in letting go. This resonated with the recent findings of the MPBV. The nature of the doctor/patient relationship with the Applicant reflected Dr Kouzmin’s failure to concede her own limitations.
47. The Respondent relies on the decision in Re Stevens and Comcare (AAT 10498, 26 October 1995). In that case, the Tribunal drew the distinction between a personal choice of medical practitioner and the choice of a particular medical practitioner who was required to provide medical care. The Respondent also relies on the decision in Corfield v Australian Postal Corporation [2000] AATA 533, where the Tribunal found that it was not reasonable to travel significant distances to obtain treatment that was available closer to the Applicant’s home. The Applicant’s compensable conditions are aggravation of developmental lumbar scoliosis with mild diffuse lumbar disc degeneration and referred pain to the lower limbs. There is appropriate competent medical treatment available nearer to the Applicant’s residence. The Respondent is not liable to pay compensation to the Applicant as the journeys for which compensation is claimed were not necessary journeys to obtain medical treatment for medical conditions for which compensation is payable. The claims do not satisfy the requirements of s 16 of the Act, and so the Applicant is not entitled to payment.
LEGISLATION
48. Section 16 of the Act provides for the payment of compensation in respect of reasonable medical expenses incurred in relation to an injury:
(1)Where an employee suffers an injury, Comcare is liable to pay, in respect of the cost of medical treatment obtained in relation to the injury (being treatment that it was reasonable for the employee to obtain in the circumstances), compensation of such amount as Comcare determines is appropriate to that medical treatment.
…
(6) Subject to subsection (7), if:
(a)compensation in respect of the cost of medical treatment is payable; and
(b)the employee reasonably incurs expenditure in doing either or both of the following:
(i)making a necessary journey for the purpose of obtaining that medical treatment;
(ii) remaining, for the purpose of obtaining that medical treatment, at a place to which the employee has made a journey for that purpose;
Comcare is liable to pay compensation to the employee:
(c)in respect of the journey—of an amount worked out using the formula:
specified rate per kilometre x numbers of kilometres travelled
where:
specified rate per kilometre means such rate per kilometre as the Minister specifies, by legislative instrument, under this subsection in respect of journeys to which this subsection applies.
numbers of kilometres travelled means the number of whole kilometres Comcare determines to have been the reasonable length of such a journey as it was necessary for the employee to make (including the return part of the journey).
(d)in respect of the employee remaining for the purpose of obtaining the treatment—of an amount equal to the expenditure so reasonably incurred in remaining for that purpose.
(7)Comcare is not liable to pay compensation under subsection (6) unless:
(a)the reasonable length of such a journey as it was necessary for the employee to make (including the return part of the journey) exceeded 50 kilometres; or
(b)if the journey made by the employee involved the use of public transport or ambulance services—the employee’s injury reasonably required the use of such transport or services regardless of the distance involved.
(8)The matters to which Comcare shall have regard in deciding questions arising under subsections (6) and (7) include:
(a)the place or places where appropriate medical treatment was available to the employee;
(b)the means of transport available to the employee for the journey;
(c)the route or routes by which the employee could have travelled; and
(d)the accommodation available to the employee.
…
CONSIDERATIONS
49. Section 16(1) of the Act provides that medical treatment must be obtained in relation to the injury and be reasonable treatment. The Applicant stated he attended Dr Kouzmin for treatment of carpal tunnel syndrome and other things in addition to his spinal condition. Dr Kouzmin stated in her report dated 26 November 2004 that she has treated the Applicant’s OSA, recurrent chest infections, carpal tunnel syndrome, erectile dysfunction and many other medical problems.
50. Section 16(6)(b) of the Act provides that compensation for travel to a medical consultation is payable (subject to the conditions applied by subsection 7) if the journey is necessary to obtain the compensable medical treatment. This implies the journey must be essential in order to obtain treatment that is reasonable for the condition resulting from the injury.
51. Section 16(7)(a) of the Act provides that the return journey must be greater than 50 kilometres.
52. Dr Kouzmin’s letterhead contains her name, address, contact details and abbreviations of her medical qualifications. There is no specific reference to an area of medicine such as Specialist Physician or Specialist Rheumatologist. She does not claim to be a specialist rheumatologist, but rather a general physician for perhaps 10 per cent of her work time. Her letter dated 12 April 2007 refers to investigated and treated a significant number of other medical and surgical conditions in consultation with other specialists. In this letter she states that she refers to other general physicians. This indicates she acknowledges she has moved from the role of a rheumatologist to at least that of a general physician managing many medical conditions. The nature of what she indicates she has undertaken is consistent with the role of a coordinating general practitioner.
53. The Applicant was aware of controversy related to his travel claims through the correspondence between him, his solicitors and the Respondent. However, it appears he did not make any enquiries of his general practitioners in Werribee or with Dr Kouzmin, about other medical care that might be available to him. There is no evidence about the impact that Dr Kouzmin’s views about doctor/patient relationships and referral patterns may have had on the Applicant. Consistent with Stevens, there is a distinct difference between consulting the doctor of choice and the ability to have that visit subsidised. There is no evidence of a medical link for which there is evidence of a formal medical referral between the majority of the medical conditions that Dr Kouzmin was managing for the Applicant and his injury from his military service,. There is evidence that there is no sub-specialised area of medicine for which Dr Kouzmin is credentialed that relates to the injury. There is no evidence that a general practitioner at Werribee could not have undertaken the nature of the medical management undertaken by Dr Kouzmin. Consistent with Reilly, there is no evidence that the nature of the doctor/patient relationship between the Applicant and Dr Kouzmin is an essential part of the therapy related to the management of the compensable injury.
FINDINGS
54. The Applicant’s compensable conditions are aggravation of developmental lumbar scoliosis with mild diffuse lumbar disc degeneration and referred pain to the left lower limb.
55. The Applicant may consult any medical practitioner of his choosing or to whom he has been referred.
56. The Applicant received a medical referral to Dr Kouzmin for her expertise in rheumatology in 1999. Dr Kouzmin undertook the management of many medical conditions that are not within the area of rheumatology and were remote from the compensable injury. Dr Kouzmin undertook the role of a general practitioner to the Applicant.
57. Treatment for the Applicant’s conditions other than related to the spine and referred pain as advised do not fall within the scope of s 16(1) of the Act.
58. Travel expenses related to the treatment for those conditions other than related to the spine and referred pain as advised is not compensable.
59. Appropriate medical treatment for the compensable injury is available within a 50 kilometre return trip of the Applicant’s residence.
DECISION
60. The provisions of ss 16(1), (6), (7) and (8) of the Act are not satisfied. Accordingly, the decision of the Respondent to disallow the Applicant’s claims for travel expenses for his consultations with Dr Kouzmin was the correct decision. The Tribunal affirms the decision under review.
I certify that the sixty [60] preceding paragraphs are a true copy of the reasons for the decision of:
Dr R. McRae, Member
(sgd): Lauren Spragg
Clerk
Date of Hearing: 19 October 2007
Date of Decision: 10 April 2008
Advocate for the Applicant: Mr B Turner, RSL Advocates Office
Counsel for the Respondent: Mr J Wallace
Solicitor for the Respondent: Ms P Heffernan, Australian Government Solicitor
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