ACC rejecting genuine claims, says surgeon
BY KATE NEWTON
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ACC is declining genuine claims for surgery on "unfair and unreasonable" grounds, a respected Wellington neurosurgeon says.
Martin Hunn, a specialist at Wellington and Wakefield hospitals, has had three patients turned down for spinal surgery since January, with ACC saying their injuries were caused by pre-existing wear and tear, not accidents.
"These are three cases where I've been more than surprised at the decision that's been made."
One of the patients, Wellington man Brandon Dixon, had his claim rejected despite ACC paying for physiotherapy for the injury before he applied for surgery.
Mr Dixon, 39, suffered a prolapsed disc in his neck during a collapsed scrum in a club rugby game last year.
He can no longer play sports and is unable to sit down for more than a few minutes because of pain in his neck and right shoulder, which also keeps him awake at night.
He is worried about his partner, Tess Bates, who is six months' pregnant with their first child. "What I can do around my home is limited. I mow the lawn and then I'm buggered for the rest of the weekend.
"My fear is I won't be able to help [Tess] when the baby arrives."
His claim was declined because his medical scans also showed there was degenerative damage near the injury – despite Mr Hunn's assessment that the degeneration was normal and not the cause of the injury.
In a letter to ACC, Mr Hunn expressed his "strong disagreement" with its decision.
"[The injury] is entirely consistent with cervical disc prolapse caused by the force imparted to his neck at the time of the scrum collapse and any other interpretation would be unfair and unreasonable."
Mr Hunn told The Dominion Post ACC's decision set a dangerous precedent. "Virtually everybody who's 40 or over is going to have some wear and tear in their neck."
Once ACC declined someone, there were "all sorts of other repercussions", he said.
"The longer treatment is delayed, the lower the chance of getting a good outcome." Because he was declined, Mr Dixon was also no longer eligible for the physiotherapy he had been having to treat his neck.
ACC has angered patients and surgeons by assessing surgery claims more strictly since October last year.
It turned down more than 8500 claims for surgery in the last financial year, compared with about 5000 the year before.
Sue North, ACC's acting director of operations, said ACC was still approving more than 80 per cent of surgery claims. It would fund about 40,000 elective surgeries this year.
ACC's costs had become unsustainable, rising from $100 million in 2003 to $250m last year, she said. Mr Dixon's GP notes had not mentioned a "specific traumatic event" during the rugby match.
However, ACC was now reconsidering its position after receiving more information from Mr Hunn. Mr Dixon could also ask for an independent review, Ms North said.
Jean-Claude Theis, New Zealand chairman of the Australasian College of Surgeons, said the college had requested a meeting with ACC to discuss how claims were being assessed by the organisation's medical advisers.
A spokesman for ACC Minister Nick Smith said the minister could not comment on cases under review.
- © Fairfax NZ News
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The biggest joke in all of ACC is their use of the word "independent". "Independent medical review", "independent case review", "independent medical assessment", etc. It's amazing how ALL of the "independent" doctors ACC has sent me to do such an incredibly thorough job of NOT finding anything wrong. With rare exception, the ACC doctors are the worst excuse for medical professionals I've ever met. They don't care what you say, they don't care what happened, they only care about not biting the hand that feed$ them. They are, collectively, just plain terrible doctors; there's no way to say it politely. Symptoms of head injury are dismissed as depression. Everything else is dismissed as "just getting older". The problem is compounded by the fact that the public system moves too slowly and that people put faith in ACC, believing that it's there to help when needed. The system isn't entirely broken, but it is suffering some very deep flaws.
As it relates to the US system - I'm originally from the states. If I was injured there and out of work I would have quickly lost my job. With that I would have lost all income and all health insurance. Then I'd be depressed for real! (And I understand that many in NZ fall through ACC's cracks and wind up there, but in the US it happens almost every time) Here I've been reasonably lucky to collect 80% of my pre-injury income and have access to therapy and rehab, and I can afford to pay for a few doctors on my own while keeping my family fed and sheltered. OTOH, most of the therapy I've been sent to was not only useless, but arguably harmful or at least the wrong treatment at the time (and then not available when it may be useful at a later time); It was done so an ACC case manager could tick the box that I'm being sent to rehab and we're both playing along.
I've since learned that part of the game is just playing along, even when they send me to the wrong treatment or therapy, because unless I'm declared permanently disabled (not something ACC or I want) they are obligated to send me to some kind of treatment, and I'm obligated to play along or lose the benefit for "resisting" or some-such. I just wish they'd send me to the treatment I need when I need it, instead of just doing it to check a box on a form.
Ive been waiting now for an ACC decision for back surgery. It's only been five months now and still waiting. Multiple calls to them each month only to be told that my records are at the consultants and it takes as long as it takes. Don't bother ringing the complaints department as they are ACC just telling u the same weak excuses. And as it turns out once your records go to the medical consultants they have no accountibility what so ever, they can take as long as they like.
I explained to them im close to losing my job because after being on light duties for the past 6 months my employer was expecting me fixed and back at work by now. So if i lose my job now. And im still limping round im practically unempoyable how does that now make me a productive kiwi trying to raise my family and pay my taxes.
And yes im over 40 so after 5 months they may yet decline it as wear and tear. That's if they make a decision this year.
My hubby had a work accident. OSH didn't want to know, he was'nt badly hurt according to the Dr. ACC paid at first then called him a malingerer and he was just having them on for the income so they stopped it. One year after the accident he had surgery only after being told by higher powers to repay him nearly $10,000.00 back pay and being told to get him urgent treatment. Almost two years after the injury he was given a scan that showed multiple tendon injuries down his left arm affecting his bicept and hand. Second op has left him with little change and is now suffering failed surgery(words from highly respected Dr and ACC didn't take any notice of him. I contacted and spoke to this Dr direct after searching for him on the net, as my hubby had seen him before. Met the Dr in Nelon Dr came from Otago and we live on the West Coast. ACC don't see it any other way and got their Dr even after we asked for a different one. He told so many lies it is worth a book. Hubby was bulldozed through many different assessments. Had they been the same assessment using the same tools a different outcome would be had. Dr's comments were worthless lies and now my hubby cannot return to his job while we struggle with 20 hrs pay each week. So now what do we do. I am trying to get other work, but jobs don't grow on native trees.
Thank you Mr. Hunn, for bringing focus, to the Huge Damage ACC, has created for thousands of Kiwis, Eleven years i have been waiting for a Neck Operation, am now Drug dependent, suffer 24/7 Pain, a Train Grab Handle hit me in the Head and Right shoulder, my spine curve is reversed, three discs are collapsed, (degenerative change)was reason ACC refused payment. Have had Two Falls due to my condition,Physio work was stopped as bone chips make it to painfull, now on Morphine Based Medication, thus cant go Shopping or Function enough to survive, with out the Support of Friends.Many Lives have been Destroyed rather than Repaired, by this Clogged up Corporation,
Scrums are dangerous, especially when done by casual players. They should be banned from Rugby. Hundress of pounds of pressure on the neck of payers is a recipe for disaster.
had my claim for physio declined by ACC for OOS because they reckon I had no problems (they said in their letter to me that they didn't think I had a problem) yea right, so that's why there's crippling pain in my hands and lower arms and I can't use a computer for more than 5 minutes, can't open bottles, can't go bowling etc etc ... but no that's apparently normal according to ACC I did dispute the decision, but the final decision was that I didn't have any issues
I ended up paying for it myself by taking out a couple of credit cards and a loan ... massive debt but at least I can function a bit better now, Thanks a lot ACC, glad to see my tax money and car rego is going to good use
RE: Robert #71, you are obviously a doctor or other medical expert, with intimate knowledge of the incident that gave rise to the "bludgers" ACC claim. If not, then you are just a nark.
I live in the U.S. and as you know we just passed a new health care bill here. My preference would be to see a single payer system, non-profit, run by our government, much as many countries around the world have. From reading remarks here, maybe I am idealistic to think such a system is workable. What are your opinions? Right now, we are at the mercy of ever upward spiraling health insurance rates although we do have some choice over our care. I'm curious to hear your views.
I have never had an issue with ACC until... last year I had a small accident which had me out of action for a few months... the whole thing could not have gone any worse. first the hospital try’s to turn me away because I didn’t live in the area, then after telling at least four different people that I hit my head and shoulder and that my arm was numb and my neck felt... well, it felt painful; waited 2hrs they x-ray my shoulder and put my arm in a sling... I again ask about my neck...2hrs later... go x-ray my neck, " it looks like its broken, we have to put it in a brace straight away" I was sent back to the waiting room for another hour then moved to a bed, ALL WITH NO NECK BRACE ON! Another hour in bed and “oh, it says here you’re meant to have a brace on, how come you don’t?" ...hhmmmm i'm not sure, i'm the patient not the doc... Any ways I was sent home with a numb arm and a very unflattering neck/back brace...two weeks later I eventually get taken to my doctor after I couldn’t string a sentence together or remember what I had for lunch. Turns out I had a nasty concussion that no one had bothered to address after hitting my head. Any ways ACC loses all of my hospital forms and then a month later tells me to ask my doctor to fill out new ones... I haven’t been paid for 3 weeks... get the new forms... " that could take up to 10 working days to process" not been paid for 5 weeks now, no rent paid for 5 weeks now ( I ended up have to move back to my parents because of it)... finally after 6 weeks of not being paid and cr*p all help from anyone, I get paid $200... I earn $600 a week... after another month of sorting I was finally paid the right amounts... ACC should have a new slogan... ‘ACC great when it works, Will screw your life up when it doesn’t" - go captian awesome -
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What I want to know is:
What percentage of people in NZ have private health insurance?
How does that number compare to people who currently/previously work for/with ACC?
A comparison of those numbers would be telling.