In September 2025, the High Court of Australia handed down its decision in Michael Stewart by his Litigation Guardian Carol Schwarzman v Metro North Hospital and Health Service [2025] HCA 34. The case marks an important development in the law of damages for personal injury, particularly where plaintiffs seek to live at home rather than in an institutional setting.  

The Court unanimously allowed Mr Stewart’s appeal, overturning earlier findings of both the Supreme Court of Queensland and its Court of Appeal. The decision clarifies the correct approach to assessing “reasonableness” in claims for compensation for future care.  

Michael Stewart’s Home Life Before Injury and Institutional Care

Mr Stewart suffered catastrophic injuries due to the negligence of the respondent, Metro North Hospital and Health Service (“MNHHS”). Prior to his injury, he lived with his brother in his own home. His son and dogs often stayed with him, and home life was central to his sense of wellbeing. After his injury, Mr Stewart was placed in institutional care.  

At trial, evidence showed he was miserable in that environment. The absence of his family and pets compounded his suffering, and his physical health was deteriorating partly because he was disengaged from therapy. Mr Stewart sought damages to cover the cost of living in a rented home with his son and dog, supported by nursing and medical care. His position was simple: home care, though more expensive than institutional care, would allow him to live with dignity, maintain family bonds, and engage better with therapy.  

The Trial Decision

The primary judge accepted that Mr Stewart could recover damages for institutional care and for the cost of additional external assistance to provide more frequent therapy. However, the judge declined to award damages for home-based care. The reasoning was framed as a balancing exercise. On one side were the potential health benefits and improved quality of life Mr Stewart might enjoy in a home setting. On the other side was the “substantial increase” in costs compared to institutional care.  

The judge concluded that it would be “unreasonable” to award damages for the higher costs of home-based care. 

The Court of Appeal

The Court of Appeal of the Supreme Court of Queensland upheld the trial judge’s reasoning and result. The Court agreed that the balancing exercise was the correct test: weighing health benefits against cost. In its view, the trial judge had properly applied principles from the High Court’s earlier decision in Sharman v Evans (1977) 138 CLR 563.  

The High Court’s Decision

The High Court unanimously disagreed with both lower courts. It held that the approach to “reasonableness” had been misconceived. The central error was the interpretation of Sharman v Evans. That case had been understood as requiring courts to weigh the health benefits of a plaintiff’s chosen care arrangement against its financial cost when deciding if compensation was reasonable. The High Court clarified that this was too narrow an approach. Instead, the Court emphasised two principles:  

 

1. Full Compensation 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 defendant’s negligence.  

 

2. Reasonableness and Choice: The assessment of what is reasonable must take into account the plaintiff’s choice of how to repair the consequences of the tort.  

 

Where a plaintiff reasonably chooses home care, the court should not simply override that choice by comparing health benefits to cost. In Mr Stewart’s case, his desire to live at home was found to be a reasonable choice. Home care was not extravagant or fanciful; it was a genuine attempt to restore a semblance of his pre-injury life.  

 

The Court held that once a plaintiff acts reasonably, the burden shifts to the defendant to show that the claimed cost could be avoided because the plaintiff unreasonably refused an alternative. MNHHS failed to establish that. There was no evidence that Mr Stewart’s preference for home care amounted to a failure to mitigate his loss.  

 

The High Court has clarified that “reasonableness” does not mean courts should conduct a cost-benefit analysis between health outcomes and financial expenditure. Instead, the inquiry is broader: was the plaintiff’s choice a reasonable way of repairing the consequences of the tort? Additionally, a plaintiff’s personal preference, particularly where it relates to dignity, family, and quality of life – is a significant factor. Courts must respect that choice unless it is plainly unreasonable.  

 

If a plaintiff acts reasonably, the onus shifts to the defendant to prove that the costs could be avoided. Defendants cannot simply point to a cheaper option. They must show the plaintiff unreasonably refused that option.  

 

This decision will likely expand the scope of damages recoverable in catastrophic injury cases. Plaintiffs who wish to live at home, even at higher cost, have stronger grounds to recover those expenses. The ruling underscores that damages are not only about physical needs but also about restoring human dignity and social connection. 

Practical Implications for Plaintiffs and Defendants

For injured plaintiffs, Stewart provides a powerful precedent. It reinforces the right to pursue damages that reflect not only medical care but also lifestyle and personal wellbeing. Plaintiffs can argue that home care, even if more expensive, is a reasonable choice where it preserves family life, engagement, and dignity.  

For defendants and insurers, the decision heightens the evidentiary burden. They must do more than suggest cheaper alternatives. To reduce damages, they must prove that the plaintiff acted unreasonably in rejecting those alternatives. This will require detailed evidence about the adequacy of the proposed care and the reasonableness of the plaintiff’s response. 

Broader Significance

The Stewart decision signals a shift in how Australian courts will approach damages assessments in catastrophic injury cases. It underscores a human-centred view of compensation. Rather than reducing the plaintiff’s life to a calculation of medical costs, the Court recognised that dignity, family connection, and personal autonomy are integral to the compensatory principle. The case also narrows the scope of Sharman v Evans, which for decades had been applied in a way that encouraged courts to conduct a strict cost-benefit analysis. By reframing “reasonableness” through the lens of plaintiff choice, the High Court has restored balance to the principle of full compensation.  

Conclusion

The High Court’s ruling in Stewart v Metro North Hospital and Health Service is a landmark in personal injury law. It confirms that plaintiffs are not confined to the cheapest form of care available. Where a home-based arrangement is a reasonable response to the consequences of injury, damages should reflect that choice. The decision is a reminder that compensation is not merely about clinical outcomes but about restoring lives.  

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