Decision
Ren v QBE Insurance (Australia) Ltd [2026] NSWPICMP 684
Sixty-Second-Or-Less Summary
A Claimant has over one hundred sessions of physiotherapy, with no sustained benefit, before requesting approval for a further eight sessions.
Are the additional eight sessions of physiotherapy reasonable and necessary?
In Ren v QBE, the Medical Review Panel concluded that the further eight sessions were not reasonable and necessary because – short-term relief notwithstanding – the continuation of passive treatment discouraged the Claimant from self-managing her symptoms and encouraged her to remain inactive.
Principles
✅ The onus is on the Claimant to demonstrate that disputed treatment is reasonable and necessary, in the circumstances.
✅ Passive forms of treatment may not be reasonable and necessary if they do not encourage self-management or an increase in function, even if they provide short-term symptom relief.
Facts
The Claimant was injured in a rear-end collision on 4 July 2024.
After receiving over 100 sessions of physiotherapy, the Claimant sought approval for a further eight sessions. The Insurer declined the request on the grounds that ongoing physiotherapy, some two years post-accident, was no longer reasonable and necessary. That decision was affirmed both on Internal Review and by the primary Medical Assessor.
The Claimant successfully sought a referral to the Medical Review Panel.
The Review Panel’s Decision
The Review Panel found that the disputed physiotherapy was not reasonable and necessary for the following reasons:
🟪 The Claimant was required to demonstrate that the disputed physiotherapy treatment was both “reasonable” and “necessary”.
🟪 Factors relevant to whether treatment is “reasonable” include the appropriateness of the treatment, the availability of alternative treatment, the cost of the treatment, the actual or potential effectiveness of the treatment and the acceptance of medical experts that the treatment is appropriate or likely to be effective.
🟪 The words “in the circumstances” directs attention to the relationship between the proposed treatment and the claimant’s injuries, rather than the motor accident.
🟪 The Claimant had already received more than 100 sessions of physiotherapy without sustained benefit.
🟪 The disputed physiotherapy was not reasonable and necessary because – short term relief notwithstanding – its continuation did not encourage self-management and encouraged the Claimant to remain inactive.
My Perspective
The decision in Ren illustrates that treatment which may have been reasonable and necessary during the acute recovery phase, post-accident, may no longer be reasonable and necessary, several years post-MVA, in the absence of sustained benefit.
The Review Panel’s full reasoning on this point is worthy of being set out in full:
[117] Whilst passive therapy in the early aftermath of an injury can be used to assist the injured person become more physically active, such interventions are no longer indicated several years after the motor accident. [The Claimant] obtains only very short-term relief from the massage and passive physiotherapy interventions. There has been no overall enduring benefit from lengthy treatment. The present passive treatments do not encourage self-management of her chronic condition. These interventions also do not encourage her to become physically active or else more functional with daily activities. In fact, these interventions promote unhelpful beliefs regarding permanent injury and incapacity.
It follows that the Review Panel concluded that the disputed treatment was not reasonable and necessary merely because it provided short-term relief. The Review Panel looked at the bigger picture and determined that the disputed physiotherapy was not reasonable and necessary because its continuation was to the Claimant’s overall detriment.
PJH
The purpose of this case note is educational and should not be relied upon as legal or financial advice. My commentary is only current as at the time of publication. Readers affected by the issues raised in this case note should seek bespoke legal advice, noting that I act for CTP Insurers and I do not accept direct instructions from those injured in motor accidents.