Making like Arnie when it comes to ACC

A blog post from LudditeJourno

Making like Arnie when it comes to ACC
Which just means coming back, in a nod to the usefulness of sci-fi in everyday life.  It doesn’t mean I’ve become a right-wing bodybuilder in the months since I’ve blogged last.
I’m going to start by posting a summary I wrote a while back, somewhere else, about the ACC Clinical Pathway review.  Partly because I wrote a lot about this earlier, and partly because I’ve had several conversations with people who protested against the ACC Pathway when it was introduced who haven’t kept up with what happened next.  Mostly because the media have shut down on it, failing to report very much at all about what the Review of the Pathway showed.

Click here to read more.

Call for inquiry into ACC

A press release by the ACC Futures Coalition

The avalanche of rejected ACC claims for surgery currently being publiciised by the NZ Herald should trigger an independent inquiry into ACC, according to the ACC Futures Coalition.
“The internal review announced today in Parliament by the Minister is not good enough”, said Hazel Armstrong spokesperson for the ACC Futures Coalition. “Indeed the fact that he has had to give ACC instructions to fairly meet its legislative obligations is an admission that ACC has lost its direction.
“We are daily seeing a litany of poor decisions by ACC using degeneration and pre-existing conditions as a rationale to refuse legitimate claims for surgery,” said Hazel Armstrong. “Hundreds of New Zealanders who have paid their levies are being denied reasonable entitlements under the scheme.
“This is part of the same picture that we have seen developing since the beginning of last year. The government began with a manufactured crisis in ACC’s finances and have used this as a justification to deliberately and consistently undermine the scheme.
“We have seen the victims of sexual abuse put through ridiculous and stressful hoops in order to have access to counselling under the scheme. We have seen legislative change that has severely curtailed entitlements. We have seen the exclusion of those with less than 6% work-related hearing loss excluded from coverage and recent hearing regulations transfer the cost of hearing needs assessment, fitting and hearing devices onto the health system and individuals. We have seen an increase of people being pushed off ACC compensation onto sickness and invalids benefits and now there is a growing group of ordinary New Zealanders being denied surgery for injuries that most sensible people would see as being appropriately covered by ACC,” said Ms. Armstrong.
“There is a pattern here and that pattern is about discrediting our world-class ACC scheme so that it can be set up for radical change, probably involving full or partial privatisation,” said Ms Armstrong. “ACC is utilising private sector insurance techniques which are impacting negatively on legitimate claimants. The last thing we need is more private sector involvement.
“When the government finally undertook a review of ACC’s processes in the area of sensitive claims it revealed problems with ACC’s approach and a rethinking of how the claims of sexual abuse victims were being managed,” said Ms. Armstrong. “With this latest list of problems it is clear that we need a comprehensive and independent inquiry into how ACC is performing against the principles on which it was established and how it can be restored to meet those principles again.
“We call on the government or the Transport and Industrial Relations Select Committee to establish such an inquiry as soon as possible,” Ms Armstrong said.
The ACC Futures Coalition consists of community groups, academics, organisations representing people who need support from ACC, health treatment providers and unions who have come together around the following aim: To build cross-party support for retaining the status of ACC as a publicly-owned single provider committed to the ‘Woodhouse Principles’, with a view to maintaining and improving the provision of injury prevention, treatment, rehabilitation and ‘no fault’ compensation social insurance system for all New Zealanders.

http://www.scoop.co.nz/stories/PO1012/S00181/call-for-inquiry-into-acc.htm

Question to Minister: ACC - pre-existing and/or degenerative conditions

Hon Jim Anderton (Leader - Progressive) to the Minister for ACC: Does he have any concerns about the way ACC in general and claims general manager Denise Cosgrove in particular is interpreting ACC legislation regarding personal injury claims, which are being declined on the basis of degeneration or pre-existing conditions?
Hon Tony Ryall (Acting Minister for ACC) : No, I have no concerns about any individual Accident Compensation Corporation employees. However, I have stated my concern as to the number of complaints I receive from members of Parliament and the public, and I have given ACC very clear instructions that where elective surgery is required as a consequence of accidents, it needs to fairly meet those legislative obligations. ACC has commenced an internal review of the decision-making process. This review will include consultation with key external stakeholders and is expected to conclude in March next year.
Hon Jim Anderton: Will claims by specialist orthopaedic surgeons that ACC uses a group of retired or general surgeons to decline claims on the basis of pre-existing conditions or degeneration, based on X-ray or scan results only and without ever seeing the patient, be part of the ACC review process?
Hon Tony Ryall: I am not able to give that detail to the member, other than to say, of course, that often clinical judgment is involved. We have gone from a situation where the amount of elective surgery paid for by ACC rose between 2005 and 2009 from $130 million to $240 million, and clearly the accident rate did not double in that period.
Hon Jim Anderton: Will the fact that the ACC injury claims of young New Zealanders are being eliminated on the grounds of pre-existing conditions and the claims of older New Zealanders on the grounds of degeneration, and the threat this fact poses to the credibility of the accident compensation scheme itself, be part of the ACC review process?
Hon Tony Ryall: I know that part of the ACC review process will be reviewing the various trends. I am able to advise the member that 80 percent of such claims are accepted, and ACC expects to fund over 37,000 elective procedures this year.
Hon Jim Anderton: Will the findings of District Court judge Beattie that ACC is in a significant number of appeal cases quick to seize on degeneration as a reason to refuse claims, his action in quashing ACC’s decision to decline, and his awarding of $2,500 costs against ACC be part of the internal ACC review process?
Hon Tony Ryall: I am sure a number of factors will be taken into account in the ACC review. The fact that between 2005 and 2009 the cost of elective surgery on ACC increased from $130 million to $240 million should also be taken into account; I think the member would accept that there was not a proportionate increase in accidents during that period.
Lynne Pillay: Given that Denise Cosgrove was one of the people who insisted that ACC was correct when for nearly a year it turned down 90 percent of sexual abuse claims, and that the Minister admitted months later that ACC had handled the issue badly, will he say in several months’ time that ACC has handled surgery claims badly as well?
Hon Tony Ryall: That is a hypothetical question. We need to make sure a review tries to understand why in 2005 we paid about $130 million for elective surgery and 5 years later levy payers were paying $240 million for elective surgery, yet the accident rate certainly had not grown by that amount.

http://www.parliament.nz/en-NZ/PB/Business/QOA/8/8/0/49HansQ_20101215_00000011-11-Accident-Compensation-Pre-existing-and.htm

Degenerative ACC

A post from Tumeke! by Bomber Bradbury

Why does this Government want to destroy ACC? National have been planning to privatize ACC all along, Merrill Lynch told the Australian Insurance Shark Industry that National’s privatization of ACC would be a $200 million bonanza for them in July of 2008, that was months before ‘Cullen’s hole’ was used as the excuse to privatize. The Pricewaterhouse Coopers report points out our ACC system works better than many other examples around the world.
From the beginning National have lied about their true intentions on ACC, the second Nick got the portfolio he was gagging ACC from talking at the select committee meeting which was trying to ascertain the truth of his claims that ACC was in the crises he painted and now National have decided to abuse sexual abuse survivors by forcing them to say they are mental before they can get any counseling. This is ideology before people and it’s appalling.

Click here to read more.

ACC's culture must change

A press release by Access Support Services

Over the last year there have been numerous negative media reports about the way ACC is managing claims, especially concerning sexual abuse victims and decisions declining surgery funding. Many organisations, including medical practitioners, counsellors and lawyers, have expressed the same concerns raised by Access Support Services over the last year.
The changes to ACC have come as a result of the Government’s directive for it to reduce costs. ACC claim these changes reflect a more rigorous application of the ACC legislation than in the past and the culture of ACC had to change.
It is difficult to argue against this if you accept what ACC claim at face value. However, it does stack up when you consider the statistics. For example, the number of review applications challenging ACC’s decisions have increased from about 6000 in 2008 to 9000 last year, a 50% increase. If, as ACC claim, it is applying the legislation more rigorously then one would expect an increase in the number of decisions upheld at review when in fact it has remained constant at 75% over the past 10 years. That means 1 in 4 decisions challenged through the review process are found to be wrong.
Access Support Services own success at overturning decisions is somewhat greater, an average of 75%, which is comparable with what other ACC specialists report. But in the area of decisions relating to surgery and sensitive claims Access Support Services success is somewhat greater than its average.
“In the last year about 90% of the surgery funding decisions we have handled have been overturned and I can only recall one review decision relating to a sensitive claim not being successful since 2006” claims David Wadsworth, Head of Access Support Services.
This does not necessarily reflect our expertise in these areas, although these have made up a significant proportion of our cases in the last year, it is more indicative of the way ACC goes about its decision-making process. Access Support Services finds ACC relies too heavily on its internal medical advisors without giving proper consideration to all the circumstances, including external medical specialist opinions and the requirements of the legislation.
“We consider ACC’s decision making process is fundamentally flawed and it does not meet basic legal principles” says Mr Wadsworth.
In fact, one ACC Appeal Judge has expressed his concerns as well. In a recent District Court decision Judge Beattie commented; “ I am not impressed by the nature of the evidence upon which the respondent acted to make its decision, and that advice was given, I find, without proper regard to the legal position of the appellant's entitlement to funding for treatment.”
In another appeal decision concerning ACC’s decision to decline funding surgery Judge Beattie commented; “This Court has now heard and considered a significant number of cases on appeal where the respondent's decision to decline to fund surgery is based essentially on the fact that the claimant's shoulder is displaying aspects of degeneration commensurate with age. The respondent is very quick to seize on that identified state of affairs and use it as a reason for declinature, and I find that the present case is such an example of that.”
Access Support Services considers the changes to ACC are less about rigorous application of the legislation and more to do with an arbitrary approach to decision-making. “ACC must change its culture or its ACC’s senior management, or both. This is not what the ACC scheme is suppose to be about and it is contrary the requirements of the legislation,” says Mr Wadsworth.

http://www.scoop.co.nz/stories/PO1012/S00126/accs-culture-must-change-advocate.htm