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In Stewart v Metro North Hospital and Health Service [2025] HCA 34 (Stewart) the High Court of Australia delivered a unanimous decision that reshapes how courts assess “reasonableness” when awarding damages for future care under the Civil Liability Act 2003 (Qld) (CLA).

The case concerned whether a catastrophically injured plaintiff, residing in a nursing home, was entitled to damages to fund a return to independent living at home. The High Court held that the lower courts erred by treating reasonableness as a cost–benefit balance between home care’s advantages and its higher expense. The correct test is whether the plaintiff’s choice is a reasonable way to address the consequences of the tort and whether its cost is reasonable. This case note reviews the background, the lower courts’ reasoning, the High Court’s analysis, and the broader implications of this decision.

Background

In 2016 Mr Stewart (the plaintiff) aged 63, attended Redcliffe Hospital in Queensland with nausea and abdominal pain. Negligent treatment led to a perforated bowel, cardiac arrest, a stroke, and profound brain damage, leaving him with limited mobility and requiring lifelong care.

Before his injury, the plaintiff lived independently in rented accommodation with his brother. He shared custody of his 14-year-old son, who often stayed with him, and he owned a dog that formed part of his daily life. Following his hospital discharge, however, the plaintiff was placed in a nursing home, where he resided at the time of trial.

The plaintiff commenced proceedings against Metro North Hospital and Health Service, seeking damages that included the substantial cost of home-based nursing and medical care. Evidence at trial confirmed his clear wish to return home, where he would receive psychosocial benefits, regain some independence, and be able to enjoy family and domestic life more fully. His condition had worsened in institutional care, and expert evidence supported the benefits of a home setting.

The trial decision

At trial, the Queensland Supreme Court accepted that care at home would provide the plaintiff with significant physical, emotional, and social benefits beyond those available in the nursing home, even if the latter were supplemented with additional therapy and staff.

However, the cost differential proved determinative. The cost of home care was estimated at approximately $5 million, compared to roughly $1 million for continued nursing home care supplemented with additional services. The trial judge held that while home care offered more benefits, those benefits were not sufficiently greater to justify the significantly higher cost. The court awarded damages of about $2.19 million on the basis of institutional care.

The Court of Appeal

The Queensland Court of Appeal upheld the trial judge’s reasoning. It accepted that the plaintiff’s preference for home care was genuine and would confer meaningful benefits but concluded that the CLA required a balancing of the gain in benefits against the relative cost. On that approach, the disproportionate cost of home care rendered the claim unreasonable. The damages were adjusted slightly but remained premised on institutional care.

High Court Appeal

Special leave was granted on a narrow but crucial ground, whether the courts below had erred in their construction of the test of reasonableness under the CLA. The appellant argued that his expressed wish to return home, the ordinary nature of home living, and the uncontradicted psychological and emotional benefits of doing so were improperly discounted by the lower courts.

The High Court unanimously allowed the appeal. The Court confirmed that the purpose of damages in tort is to put the plaintiff, as far as compensation can, back in the position they would have been in if the act of negligence had not occurred. This principle is limited only by the requirement of reasonableness.

The Court held that the test is whether the plaintiff’s care choice is a reasonable way to address the consequences of the injury and whether its cost is reasonable. If so, the claim can only be displaced if the defendant proves the plaintiff failed to mitigate loss, such as by refusing a reasonable alternative. This shifts the focus from weighing cost against benefit to assessing whether the choice reflects restoration and the ordinariness of pre-injury life.

Application to the case

The Court found that the plaintiff’s choice to return home was plainly reasonable. It reflected his pre-injury circumstances, was consistent with what is ordinarily expected in the community and offered significant emotional and psychological benefits. The Court emphasised that living at home, rather than in an institution, is the ordinary arrangement for someone of the plaintiff’s background.

The Court rejected the cost–benefit approach applied by the lower courts, noting that it was legally erroneous and inconsistent with compensatory principles. The defendant failed to show that the plaintiff had acted unreasonably in rejecting the nursing home option. The case was remitted to the Queensland Supreme Court at the request of the parties for reassessment of damages on the basis that home care costs were recoverable.

The Court contrasted this case with Sharman v Evans (1977) 138 CLR 563 where a catastrophically injured young plaintiff’s preference to live at home with her mother was rejected due to associated health risks. In Evans, certain justices had adopted a proportionality analysis, weighing health benefits against costs.

The High Court in Stewart expressly disapproved of that approach, describing it as “plainly wrong.” Reasonableness, the Court said, is not confined to balancing costs against health outcomes. Instead, it requires considering whether the proposed arrangement is an ordinary and reasonable response to the injury, consistent with restoring the plaintiff’s pre-injury life.

Implications

The decision significantly strengthens the ability of plaintiffs to recover the costs of home-based care, even where those costs exceed institutional alternatives. Plaintiffs can now rely on their pre-injury lifestyle and how any proposed care arrangements reflect returning them as best as compensatory damages can to their chosen arrangement as powerful factors in establishing reasonableness. The burden shifts to defendants to prove that a plaintiff’s refusal of cheaper options amounts to a failure to mitigate loss, with proportionality between cost and benefit no longer decisive.

For personal injury law, the ruling clarifies that restoration, not cost efficiency, is the guiding principle, so long as the plaintiff’s choice is reasonable and ordinary. The Court noted earlier concerns about double counting (as raised in Evans) but held that statutory caps on general damages under the CLA largely resolve that issue. The case will have broad implications for damages assessment wherever the reasonableness of remedial measures is in dispute.

This article was published on 8 October by Carroll & O’Dea Lawyers and is based on the relevant state of the law (legislation, regulations and case law) at that date for the jurisdiction in which it is published. Please note this article does not constitute legal advice. If you ever need legal advice or want to discuss a legal problem, please contact us to see if we can help. You can reach us on 1800 059 278 or via the Contact us page on our website. If you or a loved one has been injured, use our Personal Injury Claim Check now.