High Court Clarifies Future Care Damages in Catastrophic Injury Case

Stewart v Metro North Hospital and Health Service [2025] HCA 34

In Stewart v Metro North Hospital and Health Service, the High Court unanimously overturned the Queensland Court of Appeal and has provided much needed clarity on the issue of “reasonableness” under the Civil Liability Act 2003 (Qld). The High Court found the assessment of damages for future care in catastrophic injury cases ought not be confined to a cost–benefit analysis of clinical outcomes. Rather, the High Court confirmed that the “reasonableness” of a Plaintiff’s choice to receive at-home care must be assessed holistically, with proper weight given to restoring the Plaintiff to the position they would have been if the tort had not been committed.

Case Background and Procedural History

Michael Stewart was 62 in 2016 when he was admitted to Redcliffe Hospital with abdominal pain and nausea. He received negligent treatment from Metro North Hospital and Health Service (MNHHS), which led to bowel perforations, sepsis, cardiac arrest and stroke. As a result, he was left with profound brain damage, paralysis on his right side, aphasia and was later assessed at a 96% whole person impairment. By the time the proceedings commenced, Mr Stewart was 71, largely non-verbal, and required 24-hour care.

Before his injury, Mr Stewart lived with his brother in Margate, where his teenage son Jesse and family dogs would often stay. Following his discharge from Redcliffe hospital in November 2016, Mr Stewart was transferred to institutionalised care at Ozanam Villa Aged Care Facility. Ozanam’s rules prevented him from keeping a dog, made overnight stays with his son difficult, and required advance notice for family visits. His physical condition worsened at Ozanam due to limited therapy and exercise (largely due to a lack of motivation) and Mr Stewart repeatedly expressed a desire to be cared for privately.

At trial, his litigation guardian (former partner Ms Schwarzman) sought damages to allow him to move into a rented home with professional carers, where his son and a dog could stay with him. The cost of this home-based plan was assessed at approximately $4.91 million- $3.8 million more than the cost of institutional care. It was argued that home care would support Mr Stewart’s dignity, autonomy, motivate his participation in therapy, and overall increase his quality of life.

At trial at first instance, the Court (Cooper J) accepted that Mr Stewart clearly preferred the idea of home care. The Court acknowledged home care would likely deliver some tangible therapeutical benefits but ultimately found that the significant additional cost of private care could not be justified in circumstances where Mr Stewart could receive similar, personalised care at Ozanam.  Damages were awarded to Mr Stewart accordingly and were calculated based on the cost of continued institutional care at Ozanam, supplemented by a further external therapy program.

in November 2024, on appeal, the Queensland Court of Appeal (Boddice JA, Mullins P and Ryan J) unanimously affirmed the trial judge’s approach. The Court held that the concept of “reasonable necessity” required more than the obvious preference of Mr Stewart and that the benefits of home care, while acknowledged, were not demonstrably greater than those achievable through enhanced institutional care. On that basis, the additional expense of home care was again found not to be reasonable.

Special leave to appeal was granted to the High Court to determine whether the Court of Appeal erred in its approach to reasonableness in the assessment of damages.

High Court Appeal

On 3 September 2025, the High Court (Gageler CJ, Gordon, Edelman, Jagot and Beech-Jones JJ) unanimously allowed Mr Stewart’s appeal. The Court held that both the trial judge and the Court of Appeal had misapplied the principle of “reasonableness” by confining the assessment to a cost–benefit comparison of health outcomes.

The High Court reaffirmed the compensatory principle; that is, damages in tort should, so far as money can, restore the plaintiff to the position they would have been in absent the negligence. Consequently, the High Court considered the proper inquiry to be  whether Mr Stewart’s choice of home care was a reasonable response to the tort.

In this way, the Court emphasised two aspects of “reasonableness”:

1. The plaintiff must prove that the steps taken (here, choosing home care) were reasonably required to repair the consequences of the tort.
2. Once established, the onus shifts to the defendant to show that the plaintiff unreasonably refused a cheaper alternative.

Applying these principles, the Court found Mr Stewart’s choice to receive home care was plainly reasonable in the circumstances. Prior to his injury, he had lived at home with his family and pets, and returning to such a setting offered him a far closer restoration of his pre-injury life than continued residence in institutional care. Further, the High Court held MNHHS had failed to establish that it was unreasonable for Mr Stewart to reject the cheaper option of enhanced institutional care.

Ultimately, the High Court allowed the appeal with costs, and the matter was remitted to the Supreme Court of Queensland for assessment of damages.

Anticipated Impact

For plaintiffs and practitioners, the decision confirms the restoration of ordinary life as being a central consideration to the assessment of “reasonable necessity” under the Civil Liability Act 2003 (Qld). The High Court made clear that the inquiry is not confined to a balance of health benefits, and that evidence of psychosocial and quality-of-life factors will be pivotal in demonstrating whether a care model is a reasonable response to the consequences of the tort.

For insurers and defendants, the ruling broadens the scope of compensable care. Home-based care may now be recoverable, even where institutional care is cheaper and clinically sufficient, unless it can be shown that the plaintiff acted unreasonably in declining that alternative. The burden of establishing such unreasonableness rests with the defendant and, in this case, MNHHS failed to discharge it.

For the Courts, Stewart recalibrates the application of Sharman v Evans (1977) 138 CLR 563. The High Court stressed that “reasonableness” does not entitle the Court to substitute its own balancing of cost and clinical benefit against the Plaintiff’s expressed choice. The starting point remains the compensatory principle: restoring the plaintiff, so far as money can, to their pre-injury position. The inquiry then asks whether the plaintiff’s course is a reasonable way to achieve that restoration. If it is, the onus will then shift to the defendant to prove that a cheaper alternative was unreasonably refused.