By Kieran De Silva, Paralegal, Christina Saldat, Lawyer and David Slatyer, Partner
In Stewart v Metro North Hospital and Health Service, the High Court unanimously set aside the decision of the Queensland Court of Appeal and clarified the principles governing the assessment of damages for future care in personal injury cases. The Court rejected a narrow cost-benefit approach to assessing damages for future care and instead reaffirmed that compensation must be guided by the principle of restitutio in integrum, which seeks to restore the plaintiff, as far as money can achieve, to the position they would have occupied had the tort not occurred.
This decision has implications for defendants and their insurers, particularly in catastrophic injury claims where plaintiffs wish to live in their own home or in a home setting rather than in an institution or institutional setting. It reinforces the importance of dignity, autonomy, and emotional well-being as legitimate considerations in assessing compensable loss.
In 2016, Mr Stewart received medical treatment at Redcliffe Hospital in Queensland. That treatment was found to be negligent, and Metro North Hospital and Health Service (MNHHS) admitted liability. As a result of the negligence, Mr Stewart sustained multiple serious injuries, including bowel perforations, sepsis, cardiac arrest, and stroke. He was left with lasting impairments, such as permanent brain damage, right-sided pain with no active movement in the upper limb, right lower limb contractures, and a dependence on a colostomy bag. At the time of trial in 2023, Mr Stewart was 71 years old and assessed to have a life expectancy of approximately five years.
Prior to the injury, Mr Stewart lived in a rented home with his brother in Margate Queensland, where his son and dog could stay. Following the injury, he was transferred to institutional care at Ozanam Villa, where he experienced physical deterioration and emotional distress due to the lack of therapy and inability to live with his son and dog.
Mr Stewart commenced proceedings in the Supreme Court of Queensland, seeking damages for catastrophic injuries sustained as a result of the negligence of MNHHS. He claimed compensation for a range of losses, including the cost of receiving nursing and medical care in a rented home of his own, arguing that such an arrangement would better restore his pre-injury circumstances and improve his quality of life.
The trial judge accepted that MNHHS was liable and considered three options for future care:
The trial judge accepted that Mr Stewart’s health would benefit from home care but concluded that the increased cost of such care, approximately $4.9 million compared to $1.08 million for enhanced institutional care, was not “reasonable”.[1]
The Queensland Court of Appeal upheld the trial judge’s decision, endorsing the cost-benefit analysis used to assess the reasonableness of Mr Stewart’s claim. The Court found that the marginal improvement in health outcomes did not justify the significantly higher cost of home care.[2]
The High Court unanimously allowed the appeal, holding that the lower courts had erred in their approach to ‘reasonableness’. The Court reaffirmed the compensatory principle: a plaintiff is entitled to damages that, so far as money can do, restore them to the position they would have been in but for the tort.[3]
In doing so, the Court revisited and refined the precedent set in Sharman v Evans (1977), clarifying that the assessment of reasonableness must not be reduced to a simple cost-benefit analysis.
Crucially, the Court distinguished between two aspects of reasonableness:
The Court held that Mr Stewart’s choice to live in a rented home with care was a reasonable response to repair the consequences of the tort.[5] It was not sufficient for MNHHS to argue that institutional care with additional support was cheaper; they had to prove that Mr Stewart’s refusal of that option was unreasonable, which they failed to do.[6]
The Court emphasised that the assessment of reasonableness must consider all circumstances, including the plaintiff’s prior living arrangements, mental well-being, and autonomy, not merely a cost-benefit analysis of physical health outcomes.[7]
Having the onus of proof, defendants will need to focus their attention toward evidence that is broader in scope than alternative costings and which includes emotional wellbeing and quality of life in a holistic assessment of reasonableness. The evidence must address the particular plaintiff and their circumstances. An assessment which focusses on cost as the dominant factor will fall into error.
[1] Stewart v Metro North Hospital and Health Service [2024] QSC 41 at [186].
[2] Stewart v Metro North Hospital and Health Service [2024] QCA 225 at [95].
[3] Stewart v Metro North Hospital and Health Service [2025] HCA 34 at [1].
[4] Ibid [25] – [28].
[5] Ibid [44] – [49].
[6] Ibid [52].
[7] Ibid [44], [50].
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