ACC accuses surgeons of putting through unsound claims

ACC board chairman John Judge. Photo / Mark Mitchell

Some surgeons are putting through claims they know won't be approved by ACC, its board chairman John Judge says.

ACC bosses were quizzed during a parliamentary committee hearing today about why the decline rate for claims had increased.

There has been a rash of media stories about people claiming they are unfairly being turned down for surgery.

ACC chief executive Jan White said 80 per cent of claims for elective surgery were accepted and 20 per cent declined.

Five years ago only 11 per cent were turned down.

Dr White said one reason for higher declines was that ACC had hired more assessors.

Mr Judge said the board was keeping a close eye on the issue.

"We need to actually have the public confidence that our service levels and our decisions around those things are correct," he said.

"The decline rates vary enormously between surgeons," he said.

"I don't have any doubt that some surgeons have gotten through considerably more requests for surgery for ACC than they know are justified and are leaving it to us to make the decisions on that."

Dr White said an internal review on about decision making was under way and it included talking to surgeons to get clear understanding about what's allowed.

"We are not challenging their clinical decision making, we would never challenge that...we do not intrude on that, but they are not experts on understanding the legislation or the limitation of what is funded under ACC."

She said it was ACC's role to decide what claims to approve.

"Even though the surgeons may say 'this is due to trauma' we would still look at that... what we query is whether there is a proven link between the need for surgery and an injury."

ACC was targeting long term claimants and had hired four private firms to manage 600 cases. Dr White told the committee that so far 24 of those people had been taken off ACC.

ACC got fewer claims in tough financial times, she told the committee. That could be due partly to people being worried about job security and being told to take time off.

However there was also a decrease in the non-earners account which she said could just be a public awareness of the tightness of funding.

Labour MP Chris Hipkins was concerned there were financial incentives to turn down claims or move people off ACC faster, but Dr White said that was not the case.

- NZPA