ACC’s unlawful stealth policy change
30/03/10 16:30 Filed in: News Releases
People who are injured are having their claims ruled out because of a stealth policy change at ACC that the government won’t acknowledge, Progressive Wigram MP Jim Anderton says.
In parliament today he challenged the ACC minister over a doubling in the number of cases being taken on formal review after being declined because of a pre-existing condition.
“The law is clear that ACC cannot cover situations caused wholly or substantially by pre-existing conditions or aging. Fair enough. But the law does not permit ACC to decline cover just because of a pre-existing condition.
“Since the change of government, ACC has been declining cover on that ground in what appears to be unprecedented numbers. The government refuses to fess up to a policy change, but record numbers of people are contacting me. And how else to explain a doubling in numbers of claims sent for formal review - suddenly on national taking office.”
From 2004/05 the proportion of claims sent for formal review fluctuated between 0.13 and 0.18 per cent of all claims (about 2,200, to 3,000 a year). Suddenly, when national took office the numbers increased to 0.33 per cent. That would amount to around two thousand affected people.
Many thousands more people are having their claims denied, and can’t afford the cost of formal review and court cases.
Jim Anderton says the government has no satisfactory explanation for the sudden increase.
“There must have been a policy change. According to some of the best surgeons and specialists many of the ‘pre-existing conditions’ have nothing to do with the cause of injury and ACC has no grounds in law to reject people who need cover. This policy change is therefore unlawful,” Jim Anderton said.
The information below was provided by a series of written questions from the Minister for ACC and clearly shows that ACC did not have any information on which they could base policy changes as substantial as they have been.
In parliament today he challenged the ACC minister over a doubling in the number of cases being taken on formal review after being declined because of a pre-existing condition.
“The law is clear that ACC cannot cover situations caused wholly or substantially by pre-existing conditions or aging. Fair enough. But the law does not permit ACC to decline cover just because of a pre-existing condition.
“Since the change of government, ACC has been declining cover on that ground in what appears to be unprecedented numbers. The government refuses to fess up to a policy change, but record numbers of people are contacting me. And how else to explain a doubling in numbers of claims sent for formal review - suddenly on national taking office.”
From 2004/05 the proportion of claims sent for formal review fluctuated between 0.13 and 0.18 per cent of all claims (about 2,200, to 3,000 a year). Suddenly, when national took office the numbers increased to 0.33 per cent. That would amount to around two thousand affected people.
Many thousands more people are having their claims denied, and can’t afford the cost of formal review and court cases.
Jim Anderton says the government has no satisfactory explanation for the sudden increase.
“There must have been a policy change. According to some of the best surgeons and specialists many of the ‘pre-existing conditions’ have nothing to do with the cause of injury and ACC has no grounds in law to reject people who need cover. This policy change is therefore unlawful,” Jim Anderton said.
The information below was provided by a series of written questions from the Minister for ACC and clearly shows that ACC did not have any information on which they could base policy changes as substantial as they have been.
- ACC does not capture data on ‘pre-existing degeneration’, as a decline of cover classification,
- ACC does not capture data on the proportion of claims for treatment of shoulder injuries that have been declined due to a finding of ‘pre-existing degeneration’,
- ACC does not capture data regarding the number of reviews which dispute an ACC decision to decline treatments and/or cover on the grounds of ‘pre-existing degenerative’ condition,
- ACC does not capture data regarding the number of appeals which dispute an ACC decision to decline treatment and/or cover on the grounds of ‘pre-existing degenerative’ condition,
- ACC does not keep data on the average legal costs of defending court decisions relating to the presence of a ‘pre-existing degenerative’ condition,