National

Tribunal backs government insurer's decision to stop paying for public servant's physiotherapy

The federal government has had a legal win in its crackdown on taxpayer-funded "physio for life" for injured public servants.

The Administrative Appeals Tribunal agreed that it was not reasonable for treatment to continue indefinitely.
The Administrative Appeals Tribunal agreed that it was not reasonable for treatment to continue indefinitely. 

The Administrative Appeals Tribunal has backed the government insurer's decision to stop paying for physiotherapy for the sore back of a former Defence Department staffer after seven years and 300 sessions.

The decision comes in the wake of another case where a former Sports Commission bureaucrat had his government-funded physio stopped after seven years and 500 sessions.

In the latest case, Sydney woman Elsa Alamos had been receiving regular physio treatment each week since 2006 for a back injury sustained at her work for the Department of Defence in 2000.

The therapy, combined with analgesic medications, gave her three to four days relief from the pain of her lower back.

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But in January federal workplace insurer Comcare told the former public servant, who left Defence in 2005, that it would stop paying for her physio in May, saying it was not "reasonable" for the Commonwealth to continue footing the bills.

Mrs Alamos said she suffered from panic and anxiety attacks since the insurer broke the news, fearing her health and independence would suffer and she took her case to the Tribunal, with her GP giving evidence that he believed Comcare should pay for the physio "indefinitely".

But a clinical review of the case by physiotherapist Harry Papagoras found the ongoing treatment "does not empower the injured worker to take on a greater role in self-management, does not appear to have functional goals and is not evidence-based."

AAT president James Constance agreed that it was not reasonable for the physio treatment to continue indefinitely.

"Mrs Alamos has undertaken more than 300 sessions of physiotherapy which her evidence suggests only results in a short-term alleviation of symptoms," Mr Constance wrote.

"The medical evidence strongly supports a conclusion that it is not reasonable for Mrs Alamos to obtain ongoing physiotherapy at present.

"Comcare has compensated Mrs Alamos for over 300 sessions of physiotherapy.

"I do not have evidence of the actual cost of these sessions but it would be significant.

"In my view the benefit to be gained by Mrs Alamos from continuing such treatment is outweighed by the cost which would be incurred and the possible benefits of alternative treatment."

The case is the latest in a string of matter resulting from Comcare cracking down on the provision long-term medical treatment, drugs or compensation payments to federal public servants injured on the job.

In August, former Sports Commission worker Darryl Durham appealed agianst the decision to stop his taxpayer-funded physio after 500 treatments at an estimated cost of more than $60,000.

Mr Durham's lawyers argued in the tribunal that he would be unable to work without the physio, potentially exposing the Commonwealth to an even larger compo bill.

An earlier version of this story reported incorrectly that that AAT had made a decision in the matter of Durham v Comcare. The tribunal has not yet handed down its decision.