Rope and Comcare - [2003] AATA 822

Administrative

Appeals

Tribunal

DECISION AND REASONS FOR DECISION [2003] AATA 822
ADMINISTRATIVE APPEALS TRIBUNAL )
)A2002/155 &
)A2003/280

GENERAL ADMINISTRATIVE DIVISION )

Re ELEANOR ROPE

Applicant

And

COMCARE

Respondent

DECISION

Tribunal Mr S. Webb, Member
Date21 August 2003
PlaceCanberra

Decision
The Tribunal sets aside the decisions under review and in substitution therefor decides that:

A2003/280: the occasional PNI treatment is treatment that it was reasonable for the Applicant to obtain in the circumstances, and

A2002/155: it is reasonable for the Applicant to be reimbursed the cost of travelling to obtain occasional PNI treatment in Townsville.

The Applicant is entitled to costs as agreed or taxed in accordance with the General Practice Direction.

...............................................
Mr S. Webb, Member

CATCHWORDS
COMPENSATION – reasonable medical treatment costs – psychoneuroimmunology treatment – cost of travel to Townsville - whether reasonable medical treatment – whether expenditure reasonably incurred
LEGISLATION
Safety, Rehabilitation and Compensation Act 1988 sections 4, 16
AUTHORITIES
Comcare v Watson (1998) 46 ALD 481
Re Chowdhary and Comcare (AAT 13003, 22 June 1998)
Re Popovic and Comcare [2000] 64 ALD 171
Re Pembshaw and Comcare (2000) 60 ALD 279
REASONS FOR DECISION

August 2003 Mr S. Webb, Member

APPLICATION A2002/155
1. This matter concerns an application by Mrs Eleanor Rope (“the Applicant”) for review of the decision of an authorised review officer (“ARO”) on 8 April 2002 (T21) to affirm the prior decision of a delegate of Comcare (“the Respondent”) on 4 February 2002 (T17). The ARO stated (T21 folios 59 and 60):
“On the available evidence Ms Just treated the employee from at least 1992 to mid 1999. From that time she has undergone counselling with Mr Hodge. …
Despite the extensive curriculum vitae provided in respect of Ms Just, there is no indication from the medical reports from Dr Welberry and Mr Hodge of precisely the nature of the treatment that is intended to be provided by Ms Just that cannot be provided in an area closer to the employee’s home. While Ms Just may have some expertise that is not readily available in Canberra I am not satisfied on the information provided to me that five sessions within one week would be of assistance to the employee’s condition.
Given that I am not satisfied that the proposed medical treatment is reasonable for the employee to undertake, I am also not satisfied that the costs of travelling between Canberra and Townsville are reasonably incurred expenditure for the purposes of obtaining medical treatment.”

APPLICATION A2003/280
2. As the applicant’s entitlement to compensation in respect of psychoneuroimmunology treatment was not squarely addressed on reconsideration of the Applicant’s travel claim (Application A2002/155), an ARO conducted an own motion reconsideration in order to facilitate the Tribunal’s jurisdiction. On 18 July 2003 the ARO affirmed the primary decision dated 8 February 2002 (T21), determining that (Exhibit R1):
“…the employee is not entitled to compensation under section 16 of the Act in respect of the treatment provided by Ms Just…”

3. A hearing…

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 Rope and Comcare

Details

AGLC: Rope and Comcare [2003] AATA 822
Case: [2003] AATA 822
Decision Date: 21 August 2003

CaseChat Overview and Summary

The case before the Administrative Appeals Tribunal concerned a dispute between the applicant and the respondent regarding the reimbursement of certain medical expenses. The applicant, who was seeking compensation for a work-related injury, argued that the costs associated with obtaining psychoneuroimmunology (PNI) treatment and travel expenses were reasonable and should be reimbursed. The respondent, Comcare, contested the applicant's claims, asserting that the treatment and associated costs were not reasonable.

The central legal issues before the Tribunal were whether the occasional PNI treatment was reasonable for the applicant to obtain, and whether the expenditure for travel to Townsville for this treatment was reasonably incurred. The Tribunal had to consider the nature and necessity of the treatment, the reasonableness of the travel expenses, and the overall context of the applicant's medical needs.

In addressing these issues, the Tribunal examined the evidence provided by the applicant and the expert opinions on the PNI treatment. It found that the occasional PNI treatment was reasonable for the applicant to obtain, given the specific circumstances of their condition. The Tribunal also concluded that the cost of travel to Townsville for this treatment was reasonably incurred. Consequently, the Tribunal set aside the decisions under review and determined that the applicant was entitled to reimbursement for the treatment and travel expenses. The Tribunal further ordered that the applicant was entitled to costs as agreed or taxed in accordance with the General Practice Direction.

Orders

Orders of the court

The Tribunal sets aside the decisions under review and in substitution therefor decides that:

A2003/280: the occasional PNI treatment is treatment that it was reasonable for the Applicant to obtain in the circumstances, and

A2002/155: it is reasonable for the Applicant to be reimbursed the cost of travelling to obtain occasional PNI treatment in Townsville.

The Applicant is entitled to costs as agreed or taxed in accordance with the General Practice Direction.

Background

Background to the litigation

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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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