ACC causing 'unacceptable harm' to many rejected, legitimate claimants each year, research finds

Scott Nicholls, who had to fight ACC for back-injury cover, does his back exercises on the floor at home while his wife ...
IAIN MCGREGOR/FAIRFAX NZ

Scott Nicholls, who had to fight ACC for back-injury cover, does his back exercises on the floor at home while his wife Monique watches television.

Hundreds of thousands of injured Kiwis are declined cover each year by ACC, causing "unacceptable harm" to many legitimate claimants, according to new research.

Injured people who have been denied cover "find themselves pitted against a huge, billion-dollar specialist Crown agency", the Law Foundation and University of Otago-backed report said.

The report, published on Tuesday, calls for the establishment of a personal injury commissioner to help people navigate the Accident Compensation Corporation's (ACC) "incredibly complex and difficult" complaints process.

Nicholls says ACC's complaints process is unfair and impossible to navigate.
IAIN MCGREGOR/FAIRFAX NZ

Nicholls says ACC's complaints process is unfair and impossible to navigate.

It also calls for change to the way ACC determines whether it will cover a person.

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ACC's "narrow, technical, legalistic" interpretation of the law was "shutting out" many legitimate claimants and "shifting costs" to injured people and other institutions, the report found. 

RNZ

"The bar of causation has become quite a difficult one for an injured person to overcome." A new report estimates 300,000 people could be missing out on cover, treatment or support from ACC.

It also had increasingly higher cover thresholds and asked claimants to "produce more complex evidence".

These factors led to "unacceptably low levels" of public trust and confidence, the document said.

ACC chief executive Scott Pickering said he agreed the organisation's systems and processes were "complex and difficult to navigate for customers and our own staff", but it had been going through a "transformation" over the last three years to address this.

"That's making good progress but there's still a lot of work to do," he said.

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Public trust and confidence in ACC was at 65 per cent – up from 45 per cent in 2012.

But Pickering disagreed with the report's finding that ACC was applying the law narrowly: "We rely on expert medical advice to make decisions fairly and consistently."

ACC dealt with around two million claims every year, he said.

Barrister and lead researcher Warren Forster said ACC was not working as it should as injured people did not know how to navigate the system. 

The research team of six lawyers and researchers estimated between 200,000 and 300,000 New Zealanders were denied ACC cover, treatment or support each year – more than triple ACC's own estimate of 70,000. ACC did not answer questions about the discrepancy.

Researchers looked at 2012 figures and found ACC declined 50,000 covers, 110,000 treatments, about 20,000 compensation and 30,000 rehabilitations.

"It is staggering that ACC doesn't have that data," Forster said.

He said a commissioner could develop a data-collection system, which would help injury prevention and increase ACC's accountability and transparency.

Christchurch window cleaner Scott Nicholls spent thousands of dollars in medical and lawyers' bills as he fought for cover from ACC after he injured his back while gardening in April 2015. 

ACC agreed to cover the injury as a sprain, but further tests revealed Nicholls had a prolapsed disc, which meant months off work and more expensive treatment. The organisation declined to cover the disc injury.

"I was in a lot of pain, stuck at home. It was really stressful."

Nicholls' wife Monique had a stable job and could help pay for a steroid injection that cost more than $1000, a lawyer to review ACC's decision and medical tests.

"The process was intimidating and impossible to navigate," he said.

More than a year and "five changes of mind" from ACC later, ACC granted Nicholls cover for the disc injury in May 2016.

Nicholls asked ACC to be specific about what would be covered and whether they could change their mind again, but did not get a clear response.

He and his lawyer asked for a review of the decision, which was scheduled in September 2016.

At 10pm the night before the review, ACC's lawyers sent an email to Nicholls' lawyer telling him the review was pointless because ACC had already agreed to cover the disc injury.

"I felt like they were hoping we'd quit," Nicholls said.

The review went ahead regardless and was dismissed because cover was already granted.

The organisation agreed to pay for the steroid injection and compensated Nicholls for the months he was off work.

However, ACC would not guarantee it would not change its decision again and what exactly would be covered, Nicholls said.

"It should have been a celebration, but it wasn't because they didn't commit to anything."

An ACC spokeswoman said while they could understand Nicholls' frustration at the time taken, his case was "a good example" of a claim that was "not straightforward and required external advice".

ACC Minister Michael Woodhouse was unavailable for comment on Monday.

* A previous version of this story stated that ACC cancelled the review the night before it was scheduled. ACC later clarified that the review had not been cancelled. It went ahead and was dismissed because cover for the disc injury had been granted in May 2016.

 - Stuff

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