ACC head says hard line on surgery claims needed to avoid levy blowout

The ACC's hard line on elective surgery claims is fair, affects relatively few claimants and is necessary to avoid a blowout in levies, says chairman John Judge.

Appearing before Parliament's transport and industrial relations committee, Mr Judge was questioned by Labour's ACC spokesman, Andrew Little, on the increasing number of claims going to review over the past five years. Claims usually go to review after being turned down by ACC and the vast majority of them, said Mr Judge, were for elective surgery.

In 2010, the Herald reported on 400 claimant complaints about ACC cases. After a review, the corporation last year admitted it had been rejecting too many elective surgery claims since the introduction of a harder-nosed approach four years ago.

However, Mr Little yesterday highlighted ACC data showing the number of claims going to review was continuing to rise, as was the number of those challenges being lost by the corporation.

But Mr Judge said it was not surprising the number of ACC decisions overturned on review had more than doubled since 2008.

"Before that there was absolutely no decisions being made intelligently in ACC on what was covered and what was not and that's what drove the mammoth loss of $9 billion in that period."

Commenting on the 78 per cent increase in the number of cases going to review, he said the 9271 last year were a relatively small number.

"If you take the decisions that are made positively or negatively and accepted, and the ones we win in review, we still win well over 95 per cent of all cases."

He defended the ACC's hard line on elective surgery claims.

"Frankly, the choice is between making good decisions and saying no to some people or adding 30 to 40 per cent to levies."

Mr Judge also slammed the Herald for its articles on the claims.

"Being blunt, most of the Herald articles on ACC are grossly ignorant and have been done from the basis of a rag.

"You find people that have got rather inane claims that have been denied and put them in the paper as if they're true, not giving ACC time to respond, not making sure that the claimants give us permission to respond. Basically if you want to run a Sun-type newspaper then so be it."

Mr Judge was also scathing about a Cabinet paper produced by former ACC Minister Nick Smith in which Dr Smith suggested the ACC charge employers "a surplus margin" for work account cover to allow private insurers to compete more readily with it.

"You wouldn't want to think everything in a Cabinet paper made sense would you?"

Mr Judge said he did not believe the introduction of private sector competition for the ACC would necessarily drive levies higher. Claims the ACC enjoyed advantages and could provide cover more cheaply came either from those opposed to competition, or from private insurers looking for more favourable conditions.