1. The trend of the authorities is one of treatment whose purpose is to cure or alleviate an injury. To my mind, this is consistent with my preceding comments about the largely remedial nature of the Applicant's medical evidence in so far as justification for ongoing physiotherapy is concerned.
2. Two examples of this appear in the cases of:
   • (i) Rope and Comcare [2013] AATA 280 at [31] - the Tribunal required the funded therapy to be a "purposeful activity designed, or aimed at, curing or alleviating an injury..." or which otherwise involves "... a person [who] does something in the exercise of his or her skill which is designed to alleviate an injury".
   • (ii) Jorgensen and Commonwealth of Australia [1990] AATA 129; (1990) 23 ALD 321 at 325 [5] - the Tribunal noted that "the idea of reasonableness involves objectivity. A reference to the circumstances raises subjective factors, but they are intended to be subjective factors related to the nature of the injury and not to the details of the personal life of an applicant for compensation...".
3. A previous case quite similar to the factual circumstances to the present factual circumstances arose in Alamos and Comcare [2014] AATA 629.[6] There, an applicant who had suffered ligamentous back strain in 2000 received compensation for more than 300 physiotherapy treatments from 2006 to 2014. Deputy President Constance put it aptly when he said:

In considering this requirement, it is necessary to consider all of the circumstances, and not only the beneficial effects experienced by Mrs Alamos. Without intending the list to be exhaustive, some of the factors which may be relevant considerations in the circumstances are:

• The benefit of the treatment to the injured worker;
• The long-term effect of the treatment;
• Whether the treatment is likely to cure the injury or significantly reduce its effects;
• Whether the treatment maintains the status quo;
• The cost of ongoing treatment.

There is significant evidence that the provision of long-term physiotherapy is not in the best interest of Mrs Alamos.[7]

1. Applying those comments to the present facts and with particular reference to the overall theme apparent from her medical evidence, I am not convinced that long-term physiotherapy is in the best interest of this Applicant.
2. Deputy President Constance placed significant weight (as I do) on the Clinical Framework referenced by the Respondent. He noted that:

One of the stated principles of that framework is to "empower the injured person to manage their injury." It says in part:

The key measure of treatment effectiveness is the ability of the injured person to manage their condition as independently as possible and participate in activities at home, in the community and at work. Independence does not mean being symptom-free, but rather living a functional and productive life while self-managing symptoms if they arise. Failure to empower an injured person to become independent may result in dependency on treatment, which reinforces illness behaviour and can lead to persistent pain or long-term disability.[8]

1. Unpalatable though it may seem, it is necessary for consideration to be given to a determination of whether lengthy and ongoing treatment meets the requirements of a cost-benefit analysis. This analysis essentially involves the comparative cost of the treatment against its therapeutic value. In Holt v Comcare (2007) 94 ALD 576[9] the court (per Justice Mansfield) agreeing with the approach of Justice Stone in the abovementioned case of Rope and Comcare, thought it appropriate to undertake such a cost benefit analysis and made these observations:

... There may be circumstances where treatment is unreasonable because its anticipated therapeutic benefit does not justify the expense involved in the circumstances.

... The extent to which such treatment has been undertaken in the past and the degree of its success may also be relevant...

... There may be cases... where treatment like the proposed treatment which in the past has had therapeutic benefit may no longer be reasonable because the extent of the therapeutic benefit no longer justifies the cost in the light of the past experience.[10]

1. I therefore agree with the contention of the Respondent that the cost of the claimed physiotherapy treatment outweighs the therapeutic benefit derived from the physiotherapy by the Applicant. I endorse the Respondent's reliance on Mr Papagoras' opinion that a self-management program would have the same short term benefit to the Applicant as the claimed physiotherapy.[11]
2. I therefore also agree with the Respondent's contention to the effect that for the requirements of section 16 of the SRC Act, the claimed physiotherapy:
   • (i) is not treatment 'obtained in relation to the injury'; and
   • (ii) is not treatment that is reasonable [for this Applicant] to continue to obtain in the circumstances.

I certify that the preceding 35 (thirty-five) paragraphs are a true copy of the reasons for the decision herein of Senior Member T Tavoularis

.....................[sgd]................................

[1] Exhibit 4, T-documents, T40, Clinical Panel Review dated 19 May 2014, pages 75-78.

[2] Exhibit 8, Report prepared by Mr Harry Papagoras, Physiotherapist Clinical Panel, dated 20 January 2016, page 4.

[3] Exhibit 4, T-documents, T32, Report of Dr Luke McDermott dated 14 Jan 2015, pages 58 and 59.

[4] Exhibit 5, Respondent's Amended Statement of Facts Issues and Contentions (SFIC), paragraph [5.14].

[5] Also cited: Jorgensen and Commonwealth of Australia [1990] AATA 129 at [12] (Gray J).

[6] Which followed the approach adopted by the Tribunal in the cases of Re Popovic and Comcare [2000] AATA 246 and Chowdhary and Comcare [1998] AATA 448.

[7] Alamos and Comcare [2014] AATA 629 at [23] - [25] (Deputy President Constance).

[8] Ibid at [33], quoting the Clinical Framework at pages 9 and 12.

[9] Also cited: Holt v Comcare [2007] FCA 405 (Mansfield J).

[10] Holt v Comcare [2007] FCA 405; (2007) 94 ALD 576 at [25] and [26] (Mansfield J).

[11] Exhibit 5, Respondent's Amended SFIC, para [5.13].