Accommodating Rehabilitation Options – Rogers v Suncorp Metway Insurance Limited [2013] QSC 230

Author: Joseph Vermiglio

Judgement Date: 5th September, 2013

Citation: Rogers v Suncorp Metway Insurance Limited [2013] QSC 230

Jurisdiction: Queensland Supreme Court 1

In Brief

When considering the reasonableness and appropriateness of competing accommodation options, the plaintiff’s response to current accommodation and the prognosis of medical experts cannot be overlooked during this balancing exercise.


Background

The plaintiff, aged 21, sustained a traumatic brain injury following a motor vehicle accident which occurred on 20 September 2011.  His brain injury left him with profound mobility, cognition, visual, communication and behavioural impairments.

He remained as an inpatient in hospital for approximately 19 months before he was discharged into a shared accommodation supplied by a service provider.  On 3 June 2013, the plaintiff was removed from the shared accommodation following a serious incident involving another resident.  The plaintiff was accommodated by the same service provider in another facility, on a one‑on‑one basis.

Section 51(5)(b) of the Motor Accident Insurance Act 1994 (QLD) places an obligation on the insurer to provide rehabilitation services which are reasonable and necessary.  The plaintiff requested the provision and construction of a purpose‑built residence with associated attendant care and services.  The insurer argued that it would continue to fund the current one‑on‑one accommodation and contested the construction of a purpose‑built residence as being neither reasonable nor appropriate.

Decision

The medical evidence revealed that the plaintiff engaged in temperamental and inappropriate behaviours leading to strained relationships with hospital staff, carers and other residents whilst in shared accommodation.

In determining the competing accommodation options, Justice Boddice weighed up the benefits and consequences of each, the plaintiff’s current circumstances, and the medical experts’ prognoses.  In a shared accommodation, there was a risk of physical harm to fellow residents and to the plaintiff, with the benefits of additional care providers to assist in such circumstances.  Alternatively, a purpose-built accommodation may not further the plaintiff’s rehabilitation, and there was a risk of exploitation as the plaintiff’s guardian could elect who would be able to stay in the accommodation with the plaintiff.

Justice Boddice determined that the plaintiff’s current one‑on‑one accommodation was reasonable and necessary.  The evidence suggested that the plaintiff was responding well to that accommodation and the medical experts considered it likely that his daily functioning would improve in the future, and there was a possibility for him to return to shared accommodation.  In these circumstances, the construction of a purpose‑built accommodation was considered not reasonable and necessary.


Implications

When considering competing accommodation needs in accordance with s 51(5)(b), the importance of medical experts cannot be overlooked.  If the plaintiff is responding well to existing rehabilitation services, the provision of more significant and costly accommodation requirements would be considered unreasonable and unnecessary.


[1]           Boddice J