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