The ACC files: Appeal judge overrules rejection

File photo / Supplied.

An ACC claimant won funding for shoulder surgery on appeal, despite evidence of an underlying degenerative condition.

Courier driver Ram Reddy, aged 59, felt sudden, severe pain in his right shoulder when a heavy box he lifted overbalanced. The pain forced him to stop working as a courier driver after the accident in January last year.

Orthopaedic surgeon Matthew Brick said Mr Reddy needed surgery for the "wrenching injury to a previously asymptomatic shoulder".

"I have reviewed Ram's past history and I have talked this matter over carefully with him and I can find no evidence that this was a pre-existing or chronic condition."

ACC declined funding, saying medical evidence indicated surgery was required as a result of a pre-existing gradual process condition made symptomatic by the accident. The decision was confirmed on review last December.

But in an appeal ruling this September, District Court Judge Martin Beattie quashed ACC's decision.

He said the case's facts were similar to several appeals for ACC funding of elective shoulder surgery.

"This court had heard on countless occasions specialist evidence that establishes that a person can have and function normally with a partial rotator cuff tear and whilst it is a degenerative condition, it can in most cases remain asymptomatic."

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