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No cover therefore review dismissed but ...

#1 User is offline   Battleaxe 

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Posted 18 April 2014 - 08:16 PM

Hi everyone, I recently had a review and the decision is to dismiss my application.

ACC say that because there is no cover for the condition I have they could not fund treatment, however, I consulted a specialist with this same condition that they paid $550 to, I then asked him to refer me to another specialist for the same condition where I paid an ACC levy - and have written proof from this person that ACC paid him for the balance of the consultation fee - and this specialist prescribed items that were dispensed which ACC also paid (another specialist consultation fee plus cost of items dispensed). Then I went to get physiotherapy - also ordered by the specialist aforementioned - but ACC refused "further treatment".

The first specialist - who charged and was paid $550 - used a different claim number for the subsequent specialists and prescribed items, but, all were paid by ACC.

Against this backdrop, ACC has approved and paid for - over more than 10 years - a wide range and a large number of specialists, treatments, appliances, modifications, etc without there being any cover for this condition (different but related to abovementioned). This condition is in fact caused by a treatment injury and when I complained at the abovementioned review hearing that ACC had paid all of the abovementioned specialists and treatments without cover for this (different but related) condition, the Fairway Resolution Ltd. mediator suddenly started speaking (by teleconference) to the ACC Case Manager about a "consequential" injury as opposed to a "treatment injury". The Case Manager and the mediator both agreed that the "consequential" injury is a covered injury, however, I had never heard of a "consequential" injury before this conversation. Offensively when I queried this with the Case Manager following the review hearing she then tried to say that they were talking about a "consequential" injury related to the condition under review. The truth is though that they were discussing a "consequential" injury in relation to the condition I have had for more than 10 years (different but related to the abovementioned / reviewed condition).

After typing the words outlined in paragraph above I noticed that Fairway Resolution Ltd. wrote in their decision; "... has covered right foot problems as a consequential treatment injury ... i.e. injury caused by treatment to treat a covered injury." So WHAT THE HECK is a "consequential treatment injury". And no I have never been advised by ACC that they have covered my treatment injury, consequential or not.

Fairway Resolution Ltd. quotes from the case of Medwed (86/2009) in its decision and relies on this in supporting it. In part this reads; "... there is no entitlement without cover for that injury" ... but HOW I ask could ACC then justify paying more than 10 years of consultations and treatments for my treatment injury condition that has no cover?!

Any information or advice would be welcomed as I am posting an appeal application to Wellington tomorrow.

Thanks.




Thanks.
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#2 User is offline   Aurora 

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Posted 18 April 2014 - 10:20 PM

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#3 User is offline   Aurora 

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Posted 18 April 2014 - 10:24 PM

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#4 User is offline   Aurora 

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Posted 18 April 2014 - 10:33 PM

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#5 User is offline   MINI 

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Posted 19 April 2014 - 02:12 PM

View PostBattleaxe, on 18 April 2014 - 08:16 PM, said:

Hi everyone, I recently had a review and the decision is to dismiss my application.

ACC say that because there is no cover for the condition I have they could not fund treatment, however, I consulted a specialist with this same condition that they paid $550 to, I then asked him to refer me to another specialist for the same condition where I paid an ACC levy - and have written proof from this person that ACC paid him for the balance of the consultation fee - and this specialist prescribed items that were dispensed which ACC also paid (another specialist consultation fee plus cost of items dispensed). Then I went to get physiotherapy - also ordered by the specialist aforementioned - but ACC refused "further treatment".

The first specialist - who charged and was paid $550 - used a different claim number for the subsequent specialists and prescribed items, but, all were paid by ACC.

Against this backdrop, ACC has approved and paid for - over more than 10 years - a wide range and a large number of specialists, treatments, appliances, modifications, etc without there being any cover for this condition (different but related to abovementioned). This condition is in fact caused by a treatment injury and when I complained at the abovementioned review hearing that ACC had paid all of the abovementioned specialists and treatments without cover for this (different but related) condition, the Fairway Resolution Ltd. mediator suddenly started speaking (by teleconference) to the ACC Case Manager about a "consequential" injury as opposed to a "treatment injury". The Case Manager and the mediator both agreed that the "consequential" injury is a covered injury, however, I had never heard of a "consequential" injury before this conversation. Offensively when I queried this with the Case Manager following the review hearing she then tried to say that they were talking about a "consequential" injury related to the condition under review. The truth is though that they were discussing a "consequential" injury in relation to the condition I have had for more than 10 years (different but related to the abovementioned / reviewed condition).

After typing the words outlined in paragraph above I noticed that Fairway Resolution Ltd. wrote in their decision; "... has covered right foot problems as a consequential treatment injury ... i.e. injury caused by treatment to treat a covered injury." So WHAT THE HECK is a "consequential treatment injury". And no I have never been advised by ACC that they have covered my treatment injury, consequential or not.

Fairway Resolution Ltd. quotes from the case of Medwed (86/2009) in its decision and relies on this in supporting it. In part this reads; "... there is no entitlement without cover for that injury" ... but HOW I ask could ACC then justify paying more than 10 years of consultations and treatments for my treatment injury condition that has no cover?!

Any information or advice would be welcomed as I am posting an appeal application to Wellington tomorrow.

Thanks.




Thanks.


Thats the way to go. Get it into the Court asap. you appear to be able to handle yourself well in Review. So carry on taking it to court. It is obvious that if ACC had of had a problem with if you were covered or not, they shold have determined that before you got into the Review.

Ask the Court to determine it for you. Under what act is your injury etc. You will have to know this before you know how to word your submission.

All the best of luck. I read a case that Janette Brockie had and won recently, she up north somewhere. Her sounded similar, like ACC waiting until the covered injury gets older and then yells out, no more 'cover' 'age related'. Yeay!! Well Judge told ACC NO!!!

So there you go a little light at the end of the tunnel.

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#6 User is offline   MINI 

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Posted 19 April 2014 - 02:31 PM

View PostAurora, on 18 April 2014 - 10:20 PM, said:

This kind of merry-go-round is alive and well within acc. Like you I was granted cover and then when acc was to issue a specific cover decision they did not consider any evidence on file, just sent a standard letter saying you have cover for .....the injury they had nominated to their assessors. This is very sloppy practice and falls short of the service standards acc are supposedly meeting.

The second significant flaw the reviewer found was that not only were acc trying to decline entitlements, before they established covered injuries, they also were trying to issue an entitlement decision on the claim before they had advised the claimant what the covered injury was. The cart before the horse way of doing things acc has.

Cover is such a significant part of a claim, one can only wonder why acc keep making such basic errors. Mind you in reading Powell v Accident Compensation Compensation they only have one way of approaching matters. Maybe it is to put the cart before the horse and sit back and see what transpires?

Appeal is the only way and the only language that acc understand. Also if you can find a juridical matter in your claim that is also worth a shot before the courts like Powell and K risked and won! A few in my claim - just have to narrow down which one to tackle .... appeals and the district court are the only ways of winning at present as acc rarely seem to listen to common sense or an appeal to rational thinking.


The courts are not easy above appeal. To go any higher you have to have 'point of law only' and it is not easy to have that and get it recognised, as down the Seel Leave to appeal DC, the Judge doing that is DC Judge and they dont like saying another DC Judge been naughty and made mistakes and therefore there is a point of law, so worse is allowed to happen at Special Leave to appeal to High Court on point of law only, and even though I hired a lawyer for this he cant put his point of law, as the other side has dropped a abuse of process, because I could do more that one issue at a time, so that a few years ago they got the issue of abatement and the earier issue of of interest and said that the abatement should have could have, been heard with the interest and slapped estoppel on it. I couldnt put abatement in with interest when I didnt know it was illegal for ACC to abate overseas income under the 1998 Act, at the time I took the interest. Apart from that the number of things ACC do wrong when paying us our b/d w/c is unreal. No one could handle all the mistake in one one hour session at DC. As it was there was only time enough for one issue, the more important issue got waved away from the bench.

This is why if you can, get the related issues all in one case, that way, you dont have to go back again and again.


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#7 User is offline   Aurora 

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Posted 19 April 2014 - 08:15 PM

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