not required to pay for the new drug which may slow or even reverse symptoms of MS. The court said, “slowing or arresting a decline, while medically important, simply is not the same as effecting an improvement.”


In the case of Patient Z, the court held that the shipowner was required to pay for further re- habilitation, noting that the treatment was not merely intended to slow or even reverse symptoms, but to improve the condition itself.


These cases illustrate that the concept of “cure” means an improvement, or the possibility of an improvement, in the seaman’s underlying condition. Treatments directed only to symptoms, with no prospect of curing the underlying medical condition, are generally not considered part of a shipowner’s cure obligation.


Subjective complaints of pain can be among the most troublesome for doctors to treat and in many instances, palliative treatment will be offered. When the treatment offers some prospect of improving the underlying condition causing the pain, courts consider that treatment curative and require the shipowner to pay for it. However, when there is no prospect of improving the underlying condition and the treatment is offered simply to manage the symptoms of an incurable condition, generally the shipowner should not have to pay for it under its maintenance and cure obligation.


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The distinction can be difficult for a shipowner to discern. For example, in one case, the court held the shipowner was not required to pay for treatment which was intended to relieve discogenic low back pain because the treatment would not, according to the seaman’s doctor, improve the underlying condition which the doctor said was caused by irritation of nerve fibers. In another case, the court held the shipowner may be required to pay for treatment which was intended to relieve low back pain caused by degenerative disc disease.


In both cases, the condition was considered by the seamen’s doctors to be “permanent.” The difference between the two cases was the fact that the seaman’s doctor in the latter case (degenerative disc disease) said the treatment he suggested may improve the underlying condition causing the pain, wherein the doctor in the former case (discogenic back pain) said his treatment was not aimed at improving the underlying condition (which the doctor said was incurable), but could reduce the pain caused by it.


The decision to deny a claim for cure should always be made with great caution. Difficult decisions regarding the limits of maintenance and cure should always be discussed with the Club. We find these decisions can be made less daunting with the help of competent medical case managers.


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