A diabetic says ACC is to blame for his disease after it cut off his injury payments, forcing him to live off unhealthy Chinese takeaways.
Taupo man Brian Nicholl last week won the right to appeal the insurer's decision not to pay his diabetes-related claim when a judge decided it hadn't investigated the issue properly.
Nicholl, who was diagnosed with type 2 diabetes in late 2010, says he contracted the condition after hurting his back and being unable to exercise or afford to eat well.
His claim to ACC said he had no choice but to eat unhealthy takeaways - mainly Chinese - because the insurer suspended his payments for his back injury for six months after he failed to attend appointments.
His back pain left him unable to cook for himself, plus he couldn't afford healthy food, Nicholl said.
Initially the ex-builder's claim was rejected by ACC, then rejected again by a reviewer who said information from Nicholl's doctor and an endocrinologist "fell short" of establishing a causal link between the back claim and diabetes.
An ACC medical adviser wrote that "diabetes causation was considered to be multifactoral" and that the main contributing factors were genetic and lifestyle choices - often choices from childhood.
Nicholl took the reviewer's decision to court, telling the Sunday Star-Times that the insurer trying to argue that diabetes was in his family and genes was "absolute rubbish".
"I used to be a supremely fit builder, jumping out of my own skin, hunting and tramping all over New Zealand. It is very frustrating not being able to cook and I have put on quite a bit of weight because of it," he said.
After considering the appeal, Judge David Ongley said ACC had failed to properly investigate Nicholl's claim.
The judge cited a letter from his doctor which said Nicholl's blood sugar levels were "all over the show" despite intensive care, and asked if someone could help cook his meals to improve his health.
His decision also quoted an endocrinologist who said: "Brian's diet and inability to undertake physical activity have both predisposed him to the development of type 2 diabetes."
The judge found Nicholl had no family history of diabetes and didn't really drink. He quoted a section of the ACC Act that the reviewer had overlooked and said that while there may be other causes for Nicholl's disease, "so long as the injury is a cause of significance, I can see no principal of law that would exclude cover". The judge said the case manager had "missed the point" and failed to properly investigate. "The decision declining the claim was clearly made on the wrong grounds."
He allowed the appeal and quashed the review decision, meaning ACC is now required to reinvestigate the claim and reimburse Nicholl's costs.
Nicholl was pleased he would get the review. "ACC through their propaganda machine have got people well and truly trained to think if a person hasn't got their stomach hanging out, arms and legs torn off, or if they are not a paraplegic in a wheelchair, then they must be OK."
- © Fairfax NZ News
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