Pethes and Comcare
Key Points
- Liability for the applicant's condition, a respiratory disorder, was accepted in 1989
- Between 1989 and 2016, the applicant underwent frequent remedial massage to treat back pain caused by excessive coughing
- The Tribunal found that massage, which caused temporary relief of the applicant's back pain, was no longer reasonably required as a result of her accepted condition
Background
Eva Pethes was employed as a clerk with CSIRO, where she was exposed to cigarette smoke from her co-workers and paint fumes from renovations. In 1989, Comcare accepted liability for an aggravation of sensitive respiratory tract. Ms Pethes received treatment in the form of medication, nasal sprays and weekly remedial massage therapy.
In 2016, Comcare determined that compensation was no longer payable for ongoing massage. A Reviewable Decision affirming this determination found that the massage therapy was not reasonable medical treatment for her accepted condition. Ms Pethes, who was retired, lodged an application for review with the Tribunal.
The law
With reference to section 16 of the Safety, Rehabilitation and Compensation Act 1998 (SRC Act), the Tribunal considered three issues:
- Whether remedial massage constituted medical treatment for the purpose of the Act;
- Whether the massage was obtained in relation toMs Pethes' accepted condition; and
- Whether the massage therapy was reasonable treatment in the circumstances.
Section 4(1) of the SRC Act defines medical treatment to mean, in part, therapeutic treatment obtained at the direction of a medical practitioner, including treatment by a masseur. 'Therapeutic treatment' specifically includes an examination, test or analysis done for the purpose of alleviating, an injury. Drawing on Comcare v Watson [1997] FCA 149, it was held that remedial massage, designed to alleviate pain, could constitute medical treatment.
As to whether the massage was obtained in relation to Ms Pethes' accepted condition of aggravation of sensitive respiratory tract, the Tribunal noted the broad principle expounded in Manns and Comcare [2012] AATA 462 and Topping and Comcare [2015] AATA 525, namely that 'in relation to' is a wide term that does not necessarily require a close causal connection.
Ms Pethes' constant coughing from her accepted condition caused back issues. The massage treatment was in relation to those back issues. According to the Tribunal, this was sufficient to satisfy the meaning of 'in relation to'.
Having determined the massage was treatment obtained in relation to Ms Pethes' condition, the Tribunal's last question in issue was whether the massage was reasonably required.
Reasonableness must be assessed with reference to the workers' individual circumstances: Jorgensen and Commonwealth [1990] AATA 129. Importance was placed on obiter set out in the case of Chowdhary and Comcare [1998] AATA 448. In that case, the Tribunal found that while physiotherapy which provided temporary relief from pain would in many circumstances qualify as reasonable medical treatment, treatment can reach a point where it is no longer reasonable unless it is part of a plan for the permanent improvement of the worker's health.
An analogy to Ms Pethes' situation was drawn with the decision of Topping and Comcare [2015] AATA 525, in which it was found that osteopathy had become a ritual for the worker, fostering a dependence which could be inhibiting the worker's ability to self manage her condition.
Conclusion
Applying the authorities to Ms Pethes' case, the Tribunal reasoned that, while the massage clearly provided temporary relief from her back pain, there was no clear evidence that it improved her functional ability in any substantial way. Further, Ms Pethes' symptoms caused by her accepted respiratory condition had 'plateaued', and the massage was unlikely to provide any long-term improvement of that condition. On this basis, and given the extensive costs of weekly massage, ongoing massage treatment was found not to be reasonably required by Ms Pethes.
Lessons Learnt
Treatment can be medical or therapeutic treatment obtained in relation to an accepted condition. However, if that treatment provides only temporary relief of a symptom of the accepted condition, there will come a point at which that treatment will no longer be considered reasonably required if it cannot be shown that the treatment will have any long term or permanent benefit. In our view, insurers should be wary about accepting liability for long-term complimentary therapies such as a massage or physiotherapy.
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