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Tribunal: Senior Member Dr Michelle Evans

The applicant was involved in two workplace incidents in 1986 while working for the Department of Social Security, and she suffered a prolapsed disc and mild whiplash. Comcare accepted liability for both injuries.

The applicant’s general practitioner had been issuing her with Comcare Medical Review Certificates every year certifying her unfit for work because of the workplace injuries from 1986. The latest Certificate was for the period 5 August 2016 to 5 August 2017 and stated that the applicant’s treatment included “chiropractic treatment as required”. Comcare accepted liability for the applicant’s consultations with her general practitioner and chiropractic treatment once a month until 5 August 2017.

The applicant visited the chiropractor several times in January and Comcare refused payment for all treatments except for one, in line with their accepted liability. The applicant requested a reconsideration of this decision by a Comcare Review Officer. The Officer declined liability for the additional treatments in January and reconsidered the initial acceptance of monthly chiropractic treatments. The Officer was no longer satisfied that chiropractic treatment was a reasonable medical treatment for the workplace injuries. The applicant applied to the AAT for a review of this decision.

When Comcare accepts liability for workplace injuries, they are liable to pay for the costs of medical treatment related to workplace injuries if reasonable in the circumstances.[1] Comcare was not satisfied that the chiropractic treatment was related to the workplace injuries. Comcare reviewed the available medical evidence and concluded there was no clinical justification to support that the symptoms continued to be as a result of the workplace injuries of 1986.

The applicant claimed that prior to the workplace injuries she had no back or neck problems. She believed her medical treatments managed these problems and that it was reasonable for her to be compensated for the medical treatments.

Comcare claimed that the symptoms the applicant suffers are not related to her workplace injuries but instead are related to an underlying degenerative condition that was present prior to the 1986 workplace injuries.

Comcare submitted evidence from four different doctors that suggested the chiropractic treatment was in relation to pre-existing degenerative changes in the applicant’s spine. The evidence included a report by the orthopaedic surgeon that examined the applicant in 1986, who stated that the applicant had evidence of underlying degenerative changes present prior to the workplace incidents and that these conditions were aggravated by one of the workplace injuries. 

The AAT found that the evidence suggested the applicant was no longer suffering from the effects of the workplace injuries and that the chiropractic treatment was in relation to the degenerative changes in the applicant’s spine and not in relation to the workplace injuries.

As the AAT found that the chiropractic treatment was not obtained in relation to the workplace injuries, it was not necessary for the AAT to address whether the chiropractic treatment was reasonable to obtain in the circumstances. The AAT considered this element as part of a comprehensive consideration of the application and concluded the treatment was not reasonable in the circumstances for the applicant to obtain. In reaching this conclusion, the Tribunal took into account medical evidence which showed that the treatment was not likely to result in a permanent improvement, and could actually have an adverse effect on the applicant. [2]

The AAT concluded that the correct and preferable decision was to affirm Comcare’s decision.

Read the full written decision on AustLII.

 

 

[1] Section 37(1) of the Compensation (Commonwealth Government Employees) Act 1971 and section 124(1A) of the  Safety Rehabilitation and Compensation Act 1988 (Cth)

[2] See paragraphs 39 – 46 of the full decision