Under Queensland’s workers’ compensation and CTP schemes, insurers are required to provide rehabilitation services to injured claimants in appropriate circumstances.
It is generally accepted that insurers will fund treatment that is necessary and reasonable, rather than multiple treatment modalities serving the same purpose. But rehabilitation cannot continue indefinitely. At some point, an insurer may decide that an injured person has received all reasonable treatment, or that further treatment is no longer warranted.
This raises an important question: when does rehabilitation funding come to an end, and does the answer differ between the workers’ compensation and CTP schemes?
The recent Queensland District Court decision in Simmons v QBE Insurance (Australia) Limited[2026] QDC 105 provides useful guidance.
Rehabilitation under the Motor Accident Insurance Act 1994
The Motor Accident Insurance Act 1994 (Qld) (‘MAIA’) adopts a relatively broad definition of rehabilitation.
Schedule 4 of the MAIA defines rehabilitation as the use of medical, psychological, physical, social, educational and vocational measures, individually or in combination, to:
- Restore, as far as reasonably possible, physical or mental functions lost or impaired through personal injury; and
- Optimise, as far as reasonably possible, the quality of life of a person who suffers the loss or impairment of physical or mental functions through personal injury.
Section 51 of the MAIA deals with rehabilitation services following a motor vehicle accident. Where the statutory requirements are satisfied, the issue for the CTP insurer is whether the proposed service is a reasonable and appropriate rehabilitation service in the circumstances.
Importantly, rehabilitation under the MAIA is not limited to returning someone to work. It can extend to restoring function or, where that is not possible, improving the person’s quality of life.
Rehabilitation under the Workers’ Compensation and Rehabilitation Act 2003
The goal under the Workers’ Compensation and Rehabilitation Act 2003 (Qld) (‘WCRA’) is defined differently.
Section 40 defines rehabilitation as measures designed to:
- Ensure the worker’s earliest possible return to work; or
- Maximise the worker’s independent functioning.
The workers’ compensation scheme therefore has a stronger focus on returning a worker to employment. Where that is not possible, the focus shifts to maximising independent functioning.
This distinction matters where a person has a simultaneous workers’ compensation and CTP claim. A workers’ compensation insurer’s decision that a worker has reached a “stable and stationary” condition does not necessarily deny further treatment which may be reasonable and appropriate rehabilitation under the MAIA.
Simmons v QBE Insurance (Australia) Limited [2026] QDC 105
Ms Simmons was 51 when she was injured in a motor vehicle accident on 24 May 2024. She was travelling to work when her vehicle was struck by a bus insured by QBE. As the accident occurred during her journey to work, she had both a CTP claim against QBE and a workers’ compensation claim with WorkCover Queensland.
WorkCover funded treatment including physiotherapy and a nerve root injection. Ms Simmons was later considered “stable and stationary” and WorkCover stopped funding further treatment.
Her treating neurosurgeon, Dr Hamish Alexander, recommended cervical spine surgery to address her ongoing symptoms. WorkCover declined to fund the surgery, so Ms Simmons sought funding from QBE under section 51 of the MAIA.
QBE also refused to fund the procedure, relying on medical opinions questioning whether the surgery was necessary or likely to improve Ms Simmons’ condition. The matter ultimately came before the District Court.
The Court’s approach to the medical evidence
The Court found that the proposed surgery was a reasonable and appropriate rehabilitation service and ordered QBE to fund it.
The Court considered a number of competing medical opinions. More opinions questioned the surgery than supported it, but the Court did not simply count the experts on either side. Instead, the Court considered the quality of the evidence, the reasoning behind each opinion and how well the experts engaged with the evidence for and against the proposed treatment.
The evidence supporting the surgery was ultimately preferred. The Court found that the procedure fell within the broad statutory concept of rehabilitation under the MAIA and was reasonable and appropriate in Ms Simmons’ circumstances.
WorkCover’s decision did not determine QBE’s obligations
A key point in Simmons was that WorkCover’s earlier refusal to fund the surgery did not determine QBE’s obligations. The fact that WorkCover considered Ms Simmons “stable and stationary” was not the end of the matter. QBE still had to consider the request independently under the MAIA.
This reflects the different purposes of the two schemes. Treatment that is no longer considered appropriate under the workers’ compensation scheme may still warrant consideration by a CTP insurer if it has the potential to restore function or improve a claimant’s quality of life.
What does this mean for CTP insurers?
Simmons is a useful reminder that CTP insurers should assess rehabilitation requests under the MAIA rather than simply adopting a position previously taken by a workers’ compensation insurer. When a claimant requests further treatment, the insurer needs to consider whether the treatment falls within the statutory definition of rehabilitation and, if so, whether it is reasonable and appropriate in the circumstances.
That may involve considering the available medical evidence, the likely benefits and risks of the treatment, and its connection to the accident-related injury.
The proposed cervical surgery in Simmons is a good example of why that distinction matters. WorkCover’s decision that Ms Simmons was “stable and stationary” did not prevent the surgery from being considered rehabilitation under the MAIA.
In that sense, the end of rehabilitation under one scheme does not necessarily mean the end of rehabilitation altogether.
Written by Jemma Stutz, Associate
