Lifting the Lid on Social Rehabilitation

Access Support Services is concerned about what appears to be a culture within ACC that allows staff managing claims to affect the outcome of assessments and, ultimately, the decisions ACC makes related to social rehabilitation e.g. home help, attendant care, modifications to the home and transport for independence etc.

“I have received documented evidence that, in my view, shows ACC staff conspiring to prevent certain recommendations from being made when assessing an Auckland client’s needs” says Mr Wadsworth, head of Access Support Services.

The claimant, who we will call Debbie to protect her identity, suffered a significant ankle injury in 2003, resulting in permanent impairment. The original surgery was unsuccessful and Debbie had ongoing difficulty with driving her car and going about her daily living, including showering, accessing the bath, using the kitchen safely and doing laundry.

The claim file documents supplied by ACC show an email from one ACC staff member instructing another to ensure the occupational therapist (O.T.) carrying out the assessments did not recommend a replacement vehicle or a new kitchen “as this is what the client is likely to push for”. Another communication between the O.T. and the case manager discusses Debbie’s request to assess her needs in using the bathroom. The OT writes, “If her bathroom mods [sic] are declined as per our discussion , can you clarify this with [Debbie]” [emphasis added].

“I was shocked to read these types of communications in Debbie’s claim file, especially as this was two months after ACC’s Complaints Investigator found ACC had breached four of Debbie’s rights” says Mr Wadsworth. The Complaints Investigator stated “You have not received the level of communication or service that ACC expects.

“It is not open for ACC staff to attempt to manipulate an assessment of the claimant’s needs” says Mr Wadsworth. “Assessments should be free of influence and recommendations should be based on the claimant’s needs, not a predetermined decision by ACC’s staff to deny entitlements. In my opinion this makes a complete mockery of the statutory requirements imposed on ACC when assessing the claimant’s needs and planning rehabilitation.”

Section 77 of the ACC legislation requires ACC to assess the claimant’s needs, whether injury-related or not, before deciding which services it is liable to provide or fund. In other words, ACC cannot seek to limit the recommendations an assessor may make. ACC has to consider all the recommendations when formulating the claimant’s individual rehabilitation plan (IRP).

Thankfully, the entitlements ACC’s staff set out to prevent from being recommended where eventually obtained. However, this took a four-year battle, with the assistance of Access Support Services, by challenging ACC’s decisions at a time Debbie was struggling with her injury and facing a below the knee amputation, which was eventually performed in 2009.

“I think this makes the actions of those involved, including ACC’s contracted providers, even more despicable.” says Mr Wadsworth. “ACC essentially has a monopoly on suitably qualified assessors, who appear reluctant to provide a competing assessment to contest ACC’s decisions, often sighting a conflict of interest. The problem is that if ACC’s staff can manipulate assessments as well, it leaves the claimant in a seemingly powerless position.”

Access Support Services does not believe Debbie’s case is an isolated one.

“The ACC staff involved in Debbie’s case appeared confident they could instruct the occupational therapist on what recommendations to exclude from their assessment and so I think this indicates it was not the first time, and probably not the last’ says Mr Wadsworth. “Over the years Access Support Services has received regular complaints from claimants about the way social rehabilitation assessments are conducted. We think it is time to lift the lid on how ACC’s staff go about assessing claimants’ needs when preparing the rehabilitation plan.”

Access Support Services is calling on ACC, or the Minister in charge, to conduct an independent inquiry into this practice and for recommendations to be made on what safeguards should be put in place to ensure the integrity of ACC’s assessment and decision-making process.

ENDS

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