Reasonable to have obtained medical treatment

Reasonable to have obtained medical treatment

Similar considerations arise in relation to both s 4(3) and s 16(1), which authorises the payment of compensation for medical treatment obtained in relation to a compensable injury.

Assessing reasonableness

To assist in establishing whether the medical treatment obtained was reasonable medical treatment in the circumstances, assessors should review the following evidence:

• verify the existence and nature of the compensable condition;
• examine historical medical records from the claim file and other records to establish the types of medical treatment undertaken to date.
• examine details of the medical treatment obtained, including:

• date of treatment;
• type of treatment;
• medical practitioner involved and their areas of specialisation; and
• any available opinions as to whether it was reasonable that this medical treatment was undertaken for the compensable condition.

• verify that the medical treatment obtained falls within the definition of “medical treatment” in s 4(1) of the SRC Act.]

Policy - reasonableness accepted where client acts in accordance with advice of a medical practitioner

Where a client has obtained medical treatment at the direction of, or in accordance with the advice of, a legally qualified medical practitioner, the medical treatment is to be regarded as reasonable for the purposes of s 4(3).

For details of the qualifications of medical practitioners, see the separate discussion of “Medical Qualifications”.

Case example - reasonable medical treatment

The Tribunal has considered the reasonableness of obtaining medical treatment in relation to s 16(1), which raises similar considerations as to whether it was “reasonable to obtain medical treatment”.

In O'Driscoll and Australian Telecommunications Commission (1988), the claimant suffered a neck strain injury from an epileptic seizure after undergoing myelography treatment (a specialised form of X-ray).  The issue before the Tribunal was whether the myelography was part of the medical treatment for his compensable condition, or was simply a means of the employee proving a point.  The applicant had suffered a series of work-related neck and back strains, but, on the facts, he was considered able to work and therefore not entitled to weekly compensation.  The Tribunal accepted that the applicant's treating specialist thought the myelography treatment was a reasonable procedure and that it was not unreasonable for the employee to accept this view.  It therefore held that the myelography treatment formed part of medical treatment for a previously compensable condition, and that the applicant was therefore entitled to medical costs for the results of the seizure.