ACC Must Revisit Surgery Funding Decisions

Last week ACC released the findings of its internal review into decision-making regarding funding surgery. The report revealed that in the nine months to March; 44 per cent of the ACC decisions declining to fund surgery challenged through the independent review process were overturned in favour the claimant, compared with average of 25% for all decisions for the same period. The general manager of claims management, Denise Cosgrove, said ACC was implementing recommendations from the review report which were expected to make improvements for claimants.

Access Support Services, an organisation representing claimants in the review process, first raised concerns about ACC's approach to decision-making in this area as far back as 2009. Back then it began experiencing an unprecedented number of claimants wanting to challenge ACC's surgery funding decisions and, as a result, a significant majority of these cases were overturned in their clients' favour.

Access Support Services accepts not all of ACC's decisions declining to fund surgery will be wrong. But the fact nearly half of those challenged through the independent review process over the last year were found to be wrong supports what it has been claiming for the last two years. Often these decisions mean ACC does not accept liability for the claimant's condition; which affects eligibility to other entitlements, such as weekly compensation, rehabilitation and lump sum compensation.

Access Support Services' position is that ACC must now
write to those claimants who were declined surgery funding since 2009, but not challenged through the disputes process, and offer to revisit their claims and issue a new decision, with review rights.

"Our view is that anything less than offering to revisit those decisions will demonstrate ACC is being duplicitous in saying it will be undertaking to make improvements" says Mr Wadsworth, head of Access Support Services. "I will be writing to ACC and requesting they address this matter to ensure those claimants affected have not been unfairly disadvantaged by its overzealous policy."

ENDS.

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