Press Release: 26 June 2011 (condensed version)

ACC Refuses to Revisit Surgery Decisions

In May ACC released a report on its internal review into the way it makes decisions on requests to fund surgery. This came about as a result of a sustained public outcry during 2010, which included the Orthopaedic Surgeon’s national body, claimants and politicians. In the report ACC essentially admits its decision-making process lacked legal robustness. In other words, ACC failed to properly take into account the requirements of the legislation when making its decisions and relied too heavily on its internal clinical advice. This is perhaps best demonstrated by the fact that more than 36% of those decisions contested through the independent review process since 2009 have been overturned in favour of claimants.

In response to this report, Access Support Services wrote to ACC asking what it was going to do about claimants who have been potentially disadvantage by ACC’s decision-making process. We estimate this involves up to some 18,000 claimants, being the number who have surgery funding declined over the past two years.

ACC has replied and comments (in part) “While we agree aspects of historical decisions could have been done better, the option for clients to review decisions was always made plain to clients at the time.”

Access Support Services considers ACC has an obligation to revisit those decisions because many claimants either do not have the wherewithal to fight ACC or simply accept ACC, as the state-owed corporation, must have a sound decision-making process. Despite reassurances during 2010, ACC now admits this was not the case. We think ACC’s refusal to do so is contrary to the purpose of the legislation, as set out in Section 3 of the Accident Insurance Act 2001, which states (in part):

“The purpose of this Act is to enhance the public good and reinforce the social contract represented by the first accident compensation scheme by providing for a fair and sustainable scheme for managing personal injury that has, as its overriding goals, minimising both the overall incidence of injury in the community, and the impact of injury on the community (including economic, social, and personal costs,”

The difficulty with addressing the problem from outside ACC is that claimants have three months from the date of the decision to lodge a review application. Given ACC will not revisit these decisions but says no other entitlements were affected, one approach may be to request ACC provide the other entitlements not previously considered for their condition, such as weekly compensation if they have lost income, so a new decision about entitlements are issued with fresh rights of review.

ENDS.

References:
ACC Review of Elective Surgery Decision-Making: Executive summary (13/5/11)
http://www.acc.co.nz/news/WPC093172

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