ARTICLE · 13 AUGUST 2025

What factors are relevant to whether treatment is reasonable & necessary?

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In recent case the PIC Review Panel ruled the accident materially caused the need for spinal surgery, which was reasonable & necessary.

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In Brief

Treatment relates to the injuries sustained in the accident if the accident made a material contribution, at least, to the need for treatment.
Relevant, but not determinative, factors relevant to whether treatment is reasonable and necessary include whether the treatment is appropriate, whether the treatment is likely to be effective, the availability of alternative treatment, the cost-effectiveness of the treatment and whether the treatment is supported by medical experts.

Facts

The Personal Injury Commission (PIC) published its decision in Allianz Australia Insurance Limited v Mataraci [2025] NSWPICMP 536 on 8 August 2025.

The Claimant was injured in a motor accident on 12 February 2022 when the Insured failed to stop at a stop sign.

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