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ACC case manager and assessor collude

BIG NEWS: ACC case manager and assessor collude prior to assessment to save money.

By Dave Crampton

ACC case managers are arranging to have claimants assessed on the pretence of providing rehabilitation, but in reality the aim in many cases is to save the corporation money. In some cases the case manager is colluding with the assessor to reduce entitlements before the claimant is actually reassessed.

In one case a claimant was reassessed for home help and personal care late last year. The rehabilitation outcome was “for personal care to cease and to reduce home help”. That is not a valid rehabilitation outcome, as it does not have a goal, objective or result that will assist the claimant.

The goal of this assessment was to save ACC money, not to rehabilitate the claimant, and the case manager colluded with the independent assessor and discussed how the assessment could be undertaken.

When a claimant applies for social rehabilitation – such as home help, or a wheelchair – each individual application has to be approved and, in many cases, the claimant assessed. However what is increasingly happening is when rehabilitation is approved and assessed, another assessment shortly follows with the aim of reducing the assistance. Each referral sent has a rehabilitation outcome, such as returning to independence after rehabilitation – but, rather than favouring claimants, many of these outcomes can lead to claimants being refused entitlements and the assessors given more work with ACC.

This practice by ACC is happening constantly. Furthermore, in the above instance, the assessment was done by an occupational therapist (OT) who was a former ACC employee. She now does compliant assessments for ACC that bring in more work.

On August 26 2002 the OT assessed a claimant with a badly injured back for personal care and home help. The claimant was to undergo a two week trial with ACC provided equipment to see if that assisted in coping with the injury. The OT e-mailed the case manager asking if ACC could fund the claimant’s partner as he also provides assistance, including turning the claimant in bed. This resulted in lost work hours in his self employment.

The case manager said the physio would teach the claimant how to turn herself in bed, which would take a month, and then said, ”So can the assessment reflect the 2 weeks with the equipment thing… Then we can reassess… to take out the personal care completely”.

No mention of rehabilitation. No mention of whether the equipment trial will achieve its purpose (in the end it didn’t). Just how to save ACC money by reassessing a claimant off entitlements – and telling the independent assessor what the outcome of her assessments should be, and in what time frame.

The claimant then received a letter from ACC telling her that the rehabilitation is designed to assist in independence - then added that entitlements are to be either cut or ceased and a reassessment would be done in a month for entitlements not already ceased.

Two weeks later the OT visited the claimant to see how the equipment trial was going. She e-mailed the case manager on 11 September: “She is now saying the pain is worse. I suggest (we) continue with the reduction already decided but delay it for a further two weeks. What do you think?”

The case manager replied,” I would prefer not to delay it. She has a few days to get used to the equipment.”

That evening the OT’s report arrived at the ACC, noting that the claimant commented that her pain had worsened and had requested an extension to give her time to trial out the supplied equipment before attendant care was reduced. “I indicated to her that I would pass this on to you for your consideration,” the report concluded.

However, the case manager had already told the assessor that day by e-mail that she’d prefer not to give any consideration to an extension. Meaning cut entitlements as fast as practically possible.

The following month the OT e-mailed the case manager regarding the equipment trial and said, “ I’m afraid the claimant will come up with an excuse as to why she can’t [look after herself] and claim dependence in self care”. Apparently the equipment trial was not going very well.

So as the case manager was finding it difficult to rehabilitate, she thought she’d try another option. Reassess her off her entitlements. Straight after receiving the email from the OT, the case manager sent the OT a referral asking for an assessment with the specific aim of removing personal care and reducing home assistance. The assessment didn’t go well, perhaps because the claimant was finally getting wind that ACC wanted to strip her of as many entitlements as possible rather than rehabilitating her off the scheme.

This dialogue with an assessor who is supposed to act independently of ACC is nothing short of collusion in an attempt to get an injured claimant disentitled to save the corporation money. It also provides the medical professional more ACC work.

Assessors are supposed to act independently, and provide independent reports. ACC case managers should not be telling assessors to “take out entitlements,” or share information as to the time frame to cut entitlements prior to assessments. They should be sending referrals, not with the aim of reducing entitlements, but rehabilitating claimants. Case managers, in every case, should be asking for independent reports from independent assessors. Assessors, in return, should provide written reports, without previous intervention by e-mails which may not end up on the claimant’s file.

This case is a clear example that independent assessments, in every case, are a joke. The above claimant has had her entitlements whittled down to practically nothing after several assessments and extensive dialogue between the assessor and the case manager. The claimant walks with crutches and has to be assisted by others. Yet her case manager refuses to rehabilitate her and treat her in accordance with ACC legislation and the Code of Claimants Rights.

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