ACC Playing Numbers Game - Advocate

In a recently released report titled “ACC Review of Elective Surgery Decision-making” ACC’s internal review shows that in 2009/10 of 1,167 declined surgery decisions challenged through the review process, 36% were found to be wrong. Between July 2010 and March 2011 this increased to an average of 44% of surgery decisions were overturned at review.

As late as December 2010 ACC's claims management general manager, Denise Cosgrove, was quoted as saying that while the percentage of reviews upholding ACC's decision had dropped, a significant majority were still in its favour.

“The figures show that almost half of ACC’s surgery decisions subjected to an independent review where found to be wrong, not quite the picture painted by Ms Cosgrove” says David Wadsworth, head of Access Support Services, an organisation that represents claimants in the review process. “This is an absolute scandal and it seems quite obvious to us ACC has been playing a numbers game knowing only a small percentage of claimants will challenge its decisions. This is not just about surgery; it means claimants cannot receive other entitlements under their claims, such as weekly compensation.”

ACC’s internal review into surgery decisions comes on the back of an external review commissioned by Minister for ACC, Dr Nick Smith into the way ACC managed sexual abuse claims under its new Clinical Pathways headed by Dr Jansen, ACC’s senior medical advisor. That report identified the implementation of the clinical pathways was poorly planned, without adequate consideration of the impact on clients and was introduced prematurely and precipitously.

“We are constantly being approached by claimants who are shocked to find they have been paying ACC levies all their lives only to have their claims declined when they suffer a serious injury” says Mr Wadsworth. “These claimants are not numbers or cases, they are human beings and it is high time we, as New Zealand citizens, wake up and hold those responsible to account.”

ENDS.

References
• ACC Review of Elective Surgery Decision-making (2011) pg. 10/11
• NZ Herald (16/12/10) The ACC files: Decisions overturned on review
• Clinical Review of the ACC Sensitive Claims Clinical Pathway ( 2010) pg. 29

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