An internal review by ACC is looking at how the corporation could run more efficiently and what changes need to be made, a spokeswoman said last night.
ACC's general manager of claims management Denise Cosgrove said the review was being conducted by a claims department manager and was always planned
for around this time.
"There is no way this has been brought on by the recent criticisms.
"It's an internal review which was always going to happen and it's just a part of how we run a business," she said.
The review started in October and will continue to March and will inspect ACC's policies and practices for granting insurance claims.
ACC will look at its data and processes before talking to people involved in claims - including stakeholders such as the Orthopaedic Surgeons Association.
The ACC also hit out at one of its critics last night, accusing him of having ulterior motives.
Quentin Mines, who was in charge of ACC's court work for six years in the 1980s, says the corporation has long been using degeneration as a way to decline compensation for patients.
Mr Mines believed the organisation was rejecting insurance claims on false grounds.
Mr Mines, now an ACC and medico-legal specialist in Hamilton, said in his time at the organisation officials were "blinkered" when they saw the term degeneration in a medical report.
"Degeneration was elevated out of all proper proportion a long time ago, maybe 20 years ago. It's now seeing a significance which is doing great detriment to the proper function of the scheme."
Ms Cosgrove said Mr Mines' comments were very general.
"I don't really understand what he's saying ... the legislation specifically says that it has to be wholly or substantially to the injury and it allows us on that basis for degenerative or pre-existing conditions to decline it."
She said it was likely he had ulterior motives for calling the ACC brutal and their practises illegal.
"They seem to be reasonably generic statements from someone who's probably touting for business - people who want to use his services."
Hundreds of people have contacted the Herald believing they were unfairly denied ACC cover for injury treatment and income compensation on the grounds that they had pre-existing "degenerative" conditions.
Mr Mines said harsh treatment of insurance claims had become more acute in the last few years.
Mr Mines left ACC in 1989, when he felt the atmosphere was becoming ruthless. After settling many appeals from patients where he thought ACC had been in the wrong, he was told he would be sacked if he settled any more.
His comments mirrored the stance of Auckland lawyer Simon Buckingham, who said last week that ACC was declining "on the mere whiff of degeneration, which is illegal".
ANDY JACKSON, 29
INJURY: Back
REJECTED: Degeneration
Andy Jackson, his wife and 7-month-old baby lost their savings to build a house after ACC refused to pay just hours before his back surgery.
Mr Jackson, a 29-year-old self-employed builder, injured his spine after diving while playing touch rugby.
His surgeon said there were no signs of degeneration and it was urgent that he get surgery.
Mr Jackson was put on a priority list but he received no answer from ACC for three months, despite calling them daily while his condition deteriorated.
It got to the point where he could not walk and couldn't sit or stand for any length of time, and it began to affect his bowels. Just a year earlier he had been running steep hills in Italy and the Oxfam Trailwalker in Taupo without pain.
Mr Jackson finally heard back from ACC - the night before he was scheduled to have surgery.
Funding for it was declined, immediately putting Mr Jackson $36,000 out of pocket and ruining plans to start building a house for his family by Christmas. It would have been $17,000 more if his doctor had not given him a discount out of compassion.
Mr Jackson had had injuries before, but not to the area of his spine where he needed surgery. ACC nevertheless claimed the damage was degenerative.
With his wife on maternity leave, the family had to survive on a $400-a-week sickness benefit for almost four months until he returned to work.
"It affects your whole life," he said. "It was a shock. I'm not happy."
- Michael Dickison
JOHN PROCTER, 54
INJURY: Slipped disc in neck
REJECTED: Degenerative
After a lifetime of paying ACC levies, John Procter has been reduced to a shell of himself after he was refused funding for surgery to his neck.
He suffered a slipped disc when he twisted his neck while working on a ladder at his Beachlands house in June.
But ACC said the injury was "degenerative", and Mr Procter has been left still trying to cope with excruciating pain six months later.
His employer, John Burrill, said Mr Procter had been physically fit and could take on physically demanding work without any trouble.
Now Mr Procter takes three doses of morphine a day plus sleeping pills at night as he waits to get treatment through the public health system.
"We're talking about serious drugs that will have a long-term effect. God knows what they're going to do to him," said his wife, Lynn. "I'm furious and it's gut-wrenching for me to see my husband reduced to what he is now."
Mr Procter tried driving on Saturday for work as the couple struggle without his income. After only a short stint he came home an "absolute mess" and in tears.
Mrs Procter said: "We've worked all our lives, paid our dues, and poor old Joe Bloggs that keeps the country going gets nothing. It's bulls***."
- Michael Dickison
KAHL SHARPE, 36
INJURY: Neck, shoulder
REJECTED: Degeneration
An Auckland man who has been battling ACC for almost three years says delays in treating his initial injuries have caused further injuries.
Former builder Kahl Sharpe, 36, injured his neck and right shoulder while lifting his stepson on to a top bunk in April 2008. He has been on ACC weekly compensation since but has had to fight to get medical treatment.
"The neck injury was diagnosed within two months. ACC received an urgent recommendation for surgery from the spinal specialist," he said.
"It took ACC 60 days to send a questionnaire to some guy in Christchurch for a second opinion. The guy hadn't seen me or my MRI scan and said one of the discs may have been degenerative but he couldn't definitively say so. ACC leaped on this and said they wouldn't fund it."
ACC claims general manager Denise Cosgrove said the corporation did not formally decline the surgery but needed more information before approving it. It was eventually approved and surgery was done nine months after the accident.
Mr Sharpe then sought surgery on his right shoulder. This time ACC formally refused to pay because it did not accept that the shoulder was injured in the original accident.
Mr Sharpe provided further information from his orthopaedic surgeon and ACC agreed to pay. This operation was carried out 22 months after the accident.
But 10 months on, he is still in pain.
"I've been eating painkillers on a four-hourly basis for more than two years now."
He believes the delays in the first two operations have caused what is now a painful inflammation in his left shoulder. Ms Cosgrove said ACC declined to cover further surgery because the pain "was not caused by his treatment".
But Mr Sharpe said: "It's not a treatment injury. It's a lack-of-treatment injury caused by the 22-month delay in the operation on the other shoulder."
Ms Cosgrove said ACC had now paid for two operations, 79 physiotherapy appointments, 16 GP consultations, pain assessment, rehabilitation plans, home help and other services for Mr Sharpe.
But Mr Sharpe said he had to fight for all of them.
"I still need another operation."
- Nick Jones
ANN HAMILTON, 66
INJURY: Tendon tear
REJECTED: Degeneration
Ann Hamilton tore a tendon in her arm lifting a heavy item in her garage - but ACC says the pain is caused by a degenerative injury, not the accident.
A year later, and still on the public waiting list for surgery that will relieve her ongoing pain, the 66-year-old says she has come to accept her "condition" but she warns ACC there may implications.
"Because I'm self employed and I have to pay extra ACC levies I have told them that my 'degenerative disorder' may stop me from writing out my cheque to pay my ACC levies this year."
Mrs Hamilton felt something tear in her arm while trying to lift a heavy drill press on Boxing Day last year. She was diagnosed with a rupture of the distal bicep tendon.
She paid $720 for physio, an ultrasound scan and to see an orthopaedic surgeon who wanted an MRI scan. She was told by doctors it would be covered by ACC.
ACC felt differently.
She says she was "treated like a second-class citizen" after travelling from Whitianga to Thames for a hearing to review her case.
"ACC didn't turn up ... they said it was too far for them to travel.
"They still declined my claim, saying their specialists still say because of my age this is a degenerative disorder and by trying to lift this piece of machinery I activated the condition."
ACC did, however, give Mrs Hamilton a $38 cheque for her petrol - something she has framed to remind her of their generosity.
Mrs Hamilton is on the public system's waiting list to see the surgeon but while she waits she is taking medication three times a day to deal with the pain.
- Elizabeth Binning
KARL SMITH, 43
INJURY: Wrist
REJECTED: Degenerative
A 43-year-old mechanic has developed depression and chronic pain in his wrist after he dropped a gearbox on his arm and ACC declined support.
Karl Smith was told his injury was "degenerative" so he had to pay for the surgery himself and rushed back to work through financial pressure.
He injured the wrist again at work and suffered nerve damage, putting him out of action for a year.
Mr Smith had to give up his trade and suffered depression. He continues to take strong painkillers twice a day while working as a warrant assessor.
His wife, Claire, said it had been a very long road for them.
"All because he went back to work before he was ready because ACC wouldn't cover him."
ACC staff had made them feel like criminals at every stage for expecting compensation, she said.
"If it had been up to my husband, he wouldn't have pursued any sort of compensation. He was too exhausted, depressed, and in too much pain."
She said that for a lot of people dealing with ACC was a horrible experience.
- Michael Dickison
Has ACC rejected your claim? Email newsdesk@nzherald.co.nz
