TV One’s recent piece that ACC was tightening the claims process and rejecting claims now that previously would have been accepted is right. This is particularly true for the claims that require surgery.
ACC denies this of course.
Constituent’s complaints are a very good litmus test of emerging trends. They are not precise but to provide an accurate reflection of the underlying flow of trends.
In the three electorates I work in, Taranaki King Country, Tukituki and Wairarapa, there has been a marked increase in the numbers of people approaching me frustrated by ACC; rejection of their claims. A common theme is for the claim to be rejected as the event exposed and underlying degenerative condition, therefore it was not an “accident” and their condition is simply the emergence of a pre existing condition or just age.
This is a fine line as we all age and our body does wear with time. There has always been a tension in the determining whether a condition is caused solely by an accident or is in reality a degenerative condition. This is a judgement call. The science is not precise and can be influenced. It’s increasingly being felt that the judgement criteria are shifting, tightening and rejection is more common.
ACC seems to have a line up of medical practitioners who are prepared to sign off claims as “degenerative” or “pre-existing” which makes it very difficult to argue claims.
ACC claimants are quietly being hoarded off to Work and Income for a benefit usually less advantageous and or onto public health.
Public health is being squeezed from two directions. Firstly funding is tightening, for example cuts to house help for elderly and secondly a requirement for referrals to be done within 6 months.
Health is being required to do more with less which is fine if there is surplus capacity or funds, which there isn’t. Additionally, surgery has to be completed more quickly, sped up; again this is possible if there is surplus capacity but this is not the case.
In summary, ACC claimants are now missing out where they would have been treated and back at work. They will cost the taxpayer more my languishing on a benefit waiting for their operation in public health, a system under increasing pressure.
Meanwhile, private health will have falling use and growing surplus capacity.
The only winner in this is ACC. Nick Smith will no doubt crow in the future how he has cut costs, but he won’t reveal how many, and there will be many, who are now leg ironed to a benefit and who would have been working, contributing and leading a normal life had they been rehabilitated.
Already gutting ACC – big surprise there
Interestingly ACC has always determined that an “accident” is from the point of view of the afflicted. Example, you punch me and I get injured, YOU clearly intended to punch and injure me BUT from MY pont of view, says ACC it is an accident…
A doctor can cause my injuries but this is also covered by ACC. I understand the Ministry of Health stopped releasing statistics on how we all die each year because medical misadventure and preventable medical mistake were both in the top 5 of cause of death…
It’s cost cutting of the most awful kind, quibbling over degenerative or whatever, especially from an organisation running a surplus.
The outcome of this will be many citizens carrying on as best they can in a declining condition, we will end up paying for them in other ways…
Katherine Ryan had an excellent session on this early Monday or Tuesday Morn. Agreed totally with what you are saying Rick. Jolly awful shift a bit like they say about USA health insurers denying treatment because of an underlying condition etc.
Instead of declining and creating new policy by stealth, the public deserve to know that they wont be covered for this stuff… Send out a pamphlet on that!
“ACC seems to have a line up of medical practitioners who are prepared to sign off claims as “degenerative” or “pre-existing” which makes it very difficult to argue claims.”
In the 90s my father won his case, as did most recipients, because of his own doctor and even some of the specialists ACC sent him to (before asking for a second opinion). They even tried to knock him off while waiting for a hearing.
Grant can you explain the rules over entitlements to hearing and if clients can be knocked off while waiting for appeals etc. ACC did not follow their own processes when dealing with this case.
It does sound like a return to the private insurers, when we got one they employed less medical staff and more lawyers and I guess this is how they figure they can pay less on claims.
If ACC keep doing this people will cancel their policies with ACC and choose a better insurance provider. Oh hang on – we can’t do that can we; We just need to pay more for less to keep the prop up the ideology of one size fits all.
“ACC seems to have a line up of medical practitioners who are prepared to sign off claims as “degenerative” or “pre-existing” which makes it very difficult to argue claims.”
- Which makes them liars!
That thing with your father is disgusting!
Yes Spud – Gets worse, They are not closing the office in Blenheim – Services 20,000+ people, 4 more case managers on the dole. And a staunch National electorate. (Thames likewise I gather)
burt
“If ACC keep doing this people will cancel their policies with ACC and choose a better insurance provider. Oh hang on – we can’t do that can we; We just need to pay more for less to keep the prop up the ideology of one size fits all.”
Your point would be even better if it weren’t National and Act, the trumpeters of private insurers, who were demanding the new criteria. A more cynical person than I might suggest they are deliberately creating a situation where people will WANT private providers instead