The Workers’ Compensation and Injury Management Act 1981 (WA) contains statutory limits on the amounts of compensation paid to injured workers. This article comments on the circumstances in which the entitlement to “reasonable medical and other expenses” under Clause 17 of Schedule 1 of the Act (currently fixed at $65,391) are paid.
Authorities on this area of the Act are limited, however the WA Court of Appeal recently added some further thoughts on the matter.
In Napier v BHP Billiton (Worsley Alumina) Pty Ltd  WASCA 230 the Court was asked to consider the employer’s liability to pay compensation for reasonable expenses incurred or likely to be incurred in respect of medical treatment under Clause 17.
It was noted that as Clause 17 required that the expenses be “with respect” to medical treatment, it was a (perhaps obvious) necessary condition of the entitlement that the medical treatment be with respect to an “injury” as defined under the Act. But that was not all. The reasonableness of the medical treatment with respect to the injury would be required to embrace (without being exhaustive) matters going to the appropriateness, effectiveness and cost of the treatment.
For example, a large outlay for a marginal outcome was unlikely to be reasonable. In Napier the worker sought payment for C5/6 disc replacement surgery, arguing that it was “reasonable” in the circumstances.
The Court held that the evidence fell well short of establishing that the surgery was medically and surgically appropriate for the appellant’s injury, being mechanical neck pain and further, the evidence did not establish that the surgery was medically and surgically appropriate to relieve pain caused (or contributed to) by the injury.
If either had been established, there would have been a sufficient factual foundation to characterise the claim as being one for reasonable expenses.
For more information on this paper or any Workers’ Compensation issue please contact Stephen Williams on (08) 9321 3755.
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