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