ACC's 'flimsy refusals'

By Simon Collins

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Yahaloma Hochman receives muscle treatment for her injury. Photo / Greg Bowker
Yahaloma Hochman receives muscle treatment for her injury. Photo / Greg Bowker

Hundreds of accident victims are being wrongly refused treatment on back, shoulder and knee injuries that are being mislabelled as due to "degenerative" causes, say lawyers.

Veteran Wellington accident specialist John Miller said his law firm alone now had more than 1000 accident reviews and appeals under way.

"We now have 12 lawyers in our firm working on ACC because it's just grown exponentially from the number of declines they have brought in," he said.

"Are they misinterpreting the law? In many cases I think they are, but they will say, 'We have our own medical advice that says this is all due to degeneration'."

Nationally, accident review applications jumped from 6000 in 2008 to 9182 last year as the proportion of surgery claims rejected leapt from 12 per cent to 20 per cent.

The Herald was flooded with calls and emails from rejected accident victims yesterday after reporting that 48-year-old Aucklander Yahaloma ("Diamond") Hochman was refused coverage for spinal surgery after an accident in which her car was spun across three lanes of the Southern Motorway and hit by four cars.

Accident Compensation Corporation (ACC) claims general manager Denise Cosgrove said Mrs Hochman's injuries were due to "advanced disc degeneration" which was "aggravated by the road traffic accident and not caused by [it]".

Orthopaedic Association president Gary Hooper said the corporation was taking a similar hard line with many older accident victims.

"ACC is trying to say everyone over 40 has degeneration," he said.

One of Auckland's six or seven specialist spinal surgeons, who asked to remain anonymous, said the corporation was using a handful of retired surgeons and some practising general surgeons as far afield as Timaru to declare that injuries were due to degenerative conditions on the basis of x-rays and scan results, without seeing the patients.

"We are seeing people rejected for no good reason. I've had 40, 60, 100 cases in the last few years," he said.

"This is coming to a head. There is a number of us who have to go into bat for our patients on a weekly if not daily basis."

He said the system was unfair because people who could not afford lawyers, and many immigrants who did not know the system, did not challenge ACC's decisions.

Mr Miller said ACC deliberately rejected many people on the basis that only a few would appeal.

"ACC are just acting like these rapacious overseas insurance companies, refusing them holus-bolus on the flimsy grounds of degeneration, because we all have degeneration, and hoping like some of these overseas insurance companies that people won't challenge them," he said.

His firm took ACC reviews on legal aid from anywhere in the country and had "a very good record of success", bringing in specialist surgeons to challenge ACC's favourite few.

Hamish Peart of Auckland ACC specialists Philip Schmidt and Co said his firm had won 75 to 80 per cent of reviews and appeals in the past two years.

But his firm does not take legal aid cases and he said lawyers had to assess whether there was "sufficient money in the claim" to make it worth appealing.

In Mrs Hochman's case, she was not employed so could not claim income compensation. She will get the spinal surgery she needs under the public health system next month - 14 months after her accident.

Mr Peart said it normally took three to six months to get an ACC decision reviewed by an ACC-owned company - Dispute Resolution Services - and a further six to 12 months for an appeal to the District Court, because of a backlog of cases.

"If people need surgery obviously that's a significant issue because there can be further medical complications the longer people delay," he said.

- NZ Herald

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