ACC claimants are not advised their entitlements

By Dave Crampton

Accident victims seeking rehabilitation from ACC are not being advised of their entitlements despite receiving “fact sheets” emphasising that case managers will explain all services a claimant is entitled to apply for and receive. Consequently claimants are not being rehabilitated to their fullest practicable extent.

Under the Accident Rehabilitation, Compensation Insurance Act 2001, ACC must provide information about the entitlements to which it considers the claimant may be entitled and facilitate the claimant's access to those entitlements – yet in many cases this is not happening.

ACC claimants must fill out a separate application for every individual aspect of social rehabilitation – covering the likes of home help, mobility aids and artificial limbs – before receiving the entitlement. Yet ACC is not advising claimants what they can apply for and this delays recovery. Such claimants are not receiving deserved entitlements that provide a higher quality of life because they do not know what to ask for.

For many fortunate enough to discover what they are entitled to, these approved entitlements are often not noted on a claimants rehabilitation plan, as required by legislation. Some, such as home help and the independence allowance, are provided until a claimant is reassessed and the entitlement reduced.

Not many older victims of violent crime realise they can apply for rest home care. Similarly claimants who had an accident as a minor can apply for loss of potential earnings once they reach the age of 18.

Although ACC is paying big bucks through social rehabilitation, the Corporation is not seeing too many fully rehabilitated claimants, as much of the social rehabilitation is stabilising a claimants condition rather than ensuring a claimant is back to his or her pre-accident state. So those on social rehabilitation get regularly assessed to se how much rehabilitation they actually require, and as a result of these assessment social rehab is whittled down. In its place is vocational rehabilitation, or even “pain management”.

ACC boss Gary Wilson has the view that pain is not necessarily a barrier to work, it’s how you cope with and manage that pain. So what happens is that claimants get sent to pain clinics to manage that pain but are not rehabilitated off ACC as their injury merely stabilises. Of course if you can cope with the pain of an injury you may well be assessed off the scheme if you are declared fit for work. This attitude angers District Court judges who preside over ACC appeals as they have to revoke review decisions that should never have been made.

Claimants who are earners are sometimes denied social rehabilitation at the expense of vocational rehabilitation. This is because assessments for vocational rehabilitation can lead to claimants being forced off the scheme prematurely once they are assessed to do a selected job for more than 35 hours a week.

Scoop has even heard of claimants who have been denied rehabilitation and entitlements because ACC has ignored specialist reports. These claimants, armed with self- funded fresh medical reports stating they are entitled to ACC, have applied for a Disputes Resolution Services Limited review only to lose the review. So the case goes to appeal at the District Court and is frequently withdrawn by ACC when it becomes clear that the corporation will not win the review. Although the claimant gets the desired decision, he still has to wait for some time for it and does not often get interest back paid if successful.

In some cases a Branch Medical Advisor (BMA) employed by the corporation to interpret medical information to case managers has actually ended up making decisions. The role of the BMA is solely to interpret medical information, not to make decisions. Yet this writer has seen decision letters written and signed by a BMA and has also seen draft letters written by the BMA to case managers advising them what to write in both letters to specialists and in declinature letters to claimants. In one case the BMA wrote the letter to a specialist himself in an attempt to solicit information from the specialist to back up a previously held view to disentitle.

One claimant, after applying for social rehabilitation many times, was denied on the advice of two BMA’s two different branches – Wellington and Lower Hutt. The claim was transferred between the two branches as the BMA’s in both branches were actually the claimant’s two surgeons. In these situations a claimant is stuck between a rock and a hard place as all of a sudden his former surgeons are now compliant ACC Branch Medical Advisors seeking to further their medical career working for ACC prior to retirement.

The role of the BMA needs to be investigated in order that only independent medical advice is provided. This advice should include what rehabilitation a claimant is entitled to as case managers are often ignorant of what to recommend as rehabilitation to claimants.

Until claimants are advised of their correct entitlements, and are provided them in full, the ACC assessment and rehabilitation process should be seen as nothing more than a way to provide the least amount of rehabilitation possible at the lowest possible cost.

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THURSDAY ACC claimants punished for living overseas

By Dave Crampton

ACC is telling claimants who live overseas to return to New Zealand at their own expense to be assessed for vocational assessments when they are allowed to use their own doctor to prove they are entitled to compensation from ACC. If these claimants are assessed as fit to work in an occupation nominated by the assessor, they are kicked off the scheme as they are declared rehabilitated. If they don’t return because they can’t afford to, they are also kicked off for refusing to attend an assessment, that, in some cases, they don’t even need.

While it is justifiable to ensure that claimants who live overseas are legitimately on ACC, it is important to assess only the claimants who need to be assessed. If a claimant is not fit for work and that view is backed up by a doctor, why should that claimant have to travel to New Zealand at his own expense to be told that he cannot work, or that he fit for an irrelevant job?

The Corporation insists that nominated assessors must assess claimants, but all of these assessors live and work in New Zealand. Yet there is nothing in the Accident Rehabilitation Compensation Insurance Act 2001 which precludes using qualified ACC assessors who live overseas. In fact the Act specifically says if a qualified assessor is not available the Corporation can use a suitable assessor to assess a claimant. In the case of Australia, there are many who work for similar organisations.

When claimants come back to New Zealand to be assessed, if they are classed as fit for selected work or fit for work at a nominated occupation, many have to go back overseas to work as they cannot get a work permit. Mind you, if a claimant was assessed to do a job he or she was not qualified for, and were not as fit as ACC says they were, who would employ them anyway?

In some cases claimants have been advised against travelling long distances due to the deterioration of their condition. Yet ACC will place more weight on seeking that claimant to be assessed even at the risk of their condition deterioating when it has the power to assess the claimant in the country he resides in. In these cases if a claimant refuses to travel on medical advice, even if that advice is provided to the Corporation, his entitlements will be suspended.

Those who reside overseas and have an accident while visiting New Zealand are entitled to ACC while they are in New Zealand. However should they leave the country compensation is cut. This is because the Government refuses to pass regulations allowing compensation to extend to such accident victims, as it has the power to under the ACC Act. This has serious consequences because not only do the accident victims miss out on rehabilitation and compensation, they do not have the right to sue for damages and therefore end up on social security in the country they are returning to as they are not fit to return to work. Prior to the 1992 Act, ACC covered such claimants while they were living overseas as long as the treatment was reasonable by ACC standards. These accident victims should have the right to sue for damages if they are not able to receive compensation. How can these accident victims possibly recover?

Tomorrow: ACC customer satisfaction surveys are not all they cracked up to be.

Friday ACC customer surveys avoid long term claimants

Every month, ACC contracts BRC Marketing and Social Research to interview ACC claimants and arrange customer satisfaction surveys. Much has been made of these surveys by ACC boss Garry Wilson. He says that 83 percent of those surveyed are happy with the work of ACC. Yet what Mr Wilson refuses to reveal is that long term claimants with ACC subsidiary Catalyst are never surveyed and complaints to the Ombudsman have doubled in the past couple of years. Catalyst is a subsidiary of ACC and was set up to remove claimants from the scheme. Hence surveying Catalyst claimants would dramatically bring down the overall satisfaction rate in the survey.

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