What is “reasonably necessary”?

How do I know when my treatment is reasonably necessary?

Section 60 of the Workers Compensation Act 1987 provides that:

If, as a result of any injury received by a worker, it is reasonably necessary that:

• Any medical or related treatment (other than domestic assistance) be given, or
• Any hospital treatment be given, or
• Any ambulance service be provided, or
• Any workplace rehabilitation service be provided.

The worker’s employer is liable to pay, in addition to any other compensation under the Act, the cost of that treatment or service and the related travel expenses specified in subsection (2).

Consequently, in addition to the proposed treatment for the injury being caused by a worker’s employment, the injured worker must also show that the proposed treatment is “reasonably necessary”.

In the decision of Diab v NRMA Limited [2014] NSWWCCPD  72, Deputy President Roche provided an outline of factors which should be considered in determining whether treatment is reasonably necessary. These include:

1. The appropriateness of the particular treatment;
2. The availability of alternative treatment, and its potential effectiveness;
3. The cost of the treatment;
4. The actual or potential effectiveness of the treatments; and
5. The acceptance by medical experts of the treatment being appropriate and likely to be effective.

The factors outlined in Diab are a useful guide in determining what is reasonably necessary, but will always be applied to the specific facts of a matter.  For example, an injured worker’s personal account of the benefit he was receiving from medicinal cannabis was highly relevant in determining that treatment was reasonably necessary (French v Harwood Slipway Pty Ltd & Ors [2022] NSWPIC 473).

 

Should you have had approval for treatment declined on the basis it is not reasonably necessary we recommend you contact us for our expert advice.