Pethes and Comcare (Compensation)

This matter concerned an appeal by Mrs Pethes against a decision by Comcare to refuse payment for ongoing massage treatments. Mrs Pethes had received weekly massage treatments from 1994 to 2016, which she stated lessened her pain and improved her mobility. Comcare submitted that the massage treatment was not in relation to Mrs Pethes’ accepted condition and that the treatment was not reasonable. The Administrative Appeals Tribunal was required to determine whether the massage treatment was reasonable treatment for Mrs Pethes’ accepted condition.

The Tribunal considered whether massage constituted medical treatment and whether it was obtained in relation to Mrs Pethes’ accepted condition. The Tribunal also had to assess the reasonableness of the treatment, taking into account factors such as the substantiality of its benefits, its cost, its effectiveness, its promotion of self-management, its consistency with the principles in the Framework, and its duration. The Tribunal noted that the definition of therapeutic treatment under section 4(1) of the relevant legislation included treatment given for the purpose of alleviating an injury, and that the parties did not dispute that remedial massage qualified as medical treatment. The Tribunal also applied a broad interpretation of the phrase "in relation to" as established in case law, finding that a relational connection between the treatment and the accepted condition was sufficient.

The Tribunal reasoned that while massage could be considered medical treatment and was obtained in relation to Mrs Pethes’ accepted condition, it did not meet the criteria for reasonable treatment. The evidence indicated that the benefits of the massage were occasional, short-term, and did not lead to substantial improvement in Mrs Pethes’ functionality. Furthermore, the treatment did not align well with the principles in the Framework, and the ongoing cost was substantial relative to the ephemeral and slight benefits. The Tribunal concluded that, on the whole, the massage therapy was not reasonable treatment in the circumstances.

Accordingly, the Tribunal affirmed the reviewable decision dated 12 May 2016.