When Medical Bills Meet Tax Rules - Lessons from a Heartbreaking Case

Imagine this: after years of hardship and illness, you're forced to retire early on a Total and Permanent Disability (TPD) pension from your super fund. It's your only income stream. Then come the medical bills - tens of thousands of dollars in treatments to manage the very conditions that ended your career. You might assume those costs are tax deductible as the TPD pension was payable because of this disability.

Unfortunately, a recent tribunal case shows it's not that simple. In Wannberg v Commissioner of Taxation [2025] ARTA 1561, the Administrative Review Tribunal (ART) upheld the ATO's decision to deny nearly $100,000 in medical deductions. The case is a stark reminder that the tax system draws a sharp line between earning income and dealing with your health.

The Story Behind the Case

The taxpayer, Mr Wannberg, had left the workforce due to severe mental and physical health issues caused by years of abuse. His TPD pension from his super fund was his only income. In 2024, he applied to the ATO for a private ruling, asking whether about $98,000 in medical expenses - including psychotherapy, residential treatment, and dental work - could be claimed as deductions.

His argument was heartfelt and logical: these treatments were essential to manage his disabilities and sustain his eligibility for the pension. He compared his situation to a 2010 High Court case (Anstis), where a student was allowed to deduct self-education costs linked to her Youth Allowance.

But the ATO said no - and the tribunal agreed.

Why the Deductions Failed

The key issue came down to a single piece of tax legislation: section 8-1 of the Income Tax Assessment Act 1997. To be deductible, an expense must be incurred "in gaining or producing your assessable income" and must not be of a private or domestic nature.

The tribunal found no direct link - or "nexus" - between the medical treatments and the pension income. The TPD pension was payable because of his disability, not because of any ongoing effort to maintain it. As the tribunal put it, the medical costs helped him live with his condition, but didn't produce the pension.

In other words, while staying healthy might be personally essential, it doesn't make those expenses tax-deductible. The costs were considered private in nature - similar to most therapy, medical, or dental bills.

What This Means for You

This decision offers a few key takeaways for anyone receiving disability pensions, super income streams, or other support payments:

• Understand the "nexus" test: An expense must directly help you earn your income. Medical costs for managing a condition usually don't meet that test.
• Recognise the private line: Even if a treatment relates to your ability to work, it's likely still "private" unless it directly relates to producing income.
• Treatment vs assessment: Some taxpayers are required to obtain certificates from medical practitioners to maintain a licence so that they can continue with their current income producing activities. These costs are often deductible, unless the individual receives medical treatment.
• Plan for non-deductible costs: If you rely on disability or super pensions, factor medical expenses into your financial plan. Consider insurance options, offsets, or rebates (like private health or Medicare levy exemptions) to ease the load.
• Seek advice early: Before spending large sums, get an ATO private ruling or professional advice.

The Wannberg case is a tough reminder that the tax law cares more about how income is produced than how life is lived. The system draws a firm line between personal wellbeing and income generation - and unfortunately, even genuine medical needs often fall on the wrong side of that line.

If you're unsure whether an expense might be deductible, don't guess. Talk to us first. We can help you plan ahead, stay compliant, and make the most of the rules that do work in your favour.

Please note: Many of the comments in this publication are general in nature and anyone intending to apply the information to practical circumstances should seek professional advice to independently verify their interpretation and the information's applicability to their particular circumstances.