Review No : 46/92/1988
APPLICATION FOR REVIEW
by Alan Gordon Thomas
Held at Auckland : Date 3 July 1992
Before: R M Carter, Review Officer
Present : The Applicant, his companion Miss Cynthia Lui and his counsel Ms Jill Carhart
DECISION
Issue : This application is for review of the Corporation’s decision contained in its letter of 24 April 1992 declining to pay for private hospital costs on the grounds that Mr Thomas was not prevented by his injuries from returning to his principal economic activity.
Background : On or about 27 December 1989, Mr Thomas was sailing a yacht on his own in Queen Charlotte Sound when he was pushed overboard by the sail. He was left hanging on to a rope with his right hand three miles out to sea in a storm. In a CI Advice of Injury Form signed on 7 September 1990, Mr Thomas said he strained an old injury in his right arm. At the time he couldn’t straighten it out. Now his elbow was painful and weak. A C14 First Medical Certificate signed by Dr JB Wilcox refers to recurrent tenosynovitis and epicondylitis.
The file on this matter is very large and it is not possible for me to traverse the whole of the background.
There is a form on file filled out by Dr Wilcox giving further information in which he stated that the patient recalled having wrenched his arm after falling overboard. He wrote that Mr Thomas was unable to extend his elbow fully the following day and subsequently developed pain in the right elbow. He had previously also had a right injury after falling out of a tree in 1974.
When seen on 13 March 1990, Mr Thomas had traumatic chronic epicondylitis consistent with the description given. Keyboarding aggravated the pain as did other voluntary wrist movement.
The prognosis was excellent providing the arm was rested appropriately. He might require intercurrent physiotherapy, rest and/or steroid injections. The latter had given him excellent relief. The injury was easily re-aggravated.
There is then a letter on file dated 3 October 1990 which stated that Mr Thomas was employed by Trigon Packaging Systems (NZ) Ltd from 16 January 1989 to 3 November 1989. His employment was terminated by mutual agreement.
There is also a letter on file from Mr Russell Davey stating that Mr Thomas started on 8 June 1990 and finished on 13 July 1990. This letter makes allegations against Mr Thomas.
There is also a letter on file dated 5 October 1990 from Enterprise Marketing concerning Mr Thomas’ participation in a project, it stated that if Mr Thomas was not able to operate a keyboard once the project commenced, he would be employed part time.
There is a letter on file from Mr Joe Brownlee, Orthopaedic Specialist, dated 1 November 1990, to whom Mr Thomas had been referred by the Corporation. This letter describes the condition of Mr Thomas’ right wrist and right elbow. Mr Brownlees thought that the wrist injury related to his original wrist injury in 1974 and had been aggravated by the injury in December 1989. The elbow symptoms had developed since the December 1989 accident. He recommended surgical tennis elbow relief; he did not recommend any treatment for the wrist at that stage.
Concerning Mr Thomas’ work capability, once his tennis elbow condition was resolved he considered he would be fit for light work. In the interim, any physical activity including repetitive tasks such as keyboard work were reported to cause him pain.
There is a letter on file dated 10 January 1991 giving approval for private hospital treatment costs. The amount of the Surgeon’s treatment approved was $309.40 plus accommodation and theatre. There is another letter on file dated 23 April 1991 giving approval for private hospital treatment costs. This letter stated that the Regulations allowed the Corporation to pay a maximum of $196.87 for the wrist plus either $855.00 or $731.29, and $450.65 for the elbow.
There is a memorandum on file dated 29 May that the injured person notified he did not want surgery on 14/1/91. The memorandum records that on 16 April 1991 Mr Thomas called to say he would fax through a request for private surgery. This memo relates to the two approvals above.
There is a letter on file from Career Pilot dated 25 June 1991 stating that Mr Thomas was not employed by the company and did not receive and income from it and had refused to work as a consultant.
There is a lengthy report on file dated 7 August 1991 from Insurance and Commercial Investigations [1987] Ltd dealing with various matters.
A C15 Further Medical Certificate from Dr Wilcox’s surgery states that Mr Thomas was awaiting surgery and was still unable to work as he was suffering from a painful right wrist and loss of strength. There was also right epocondylitis and shoulder pain. An earlier certificate said he could not do keyboarding.
At about that stage Ms Carhart appears to have begin to represent Mr Thomas. In a letter dated 25 October 1991 she referred to the second grant [with regard to corrective surgery] not being followed up and respectfully suggested that the Corporation communicate with Mr L John Tonkin on that matter.
There is a further report from the Investigations Company dated 5 November 1991, and there follows a report dated 21 November 1991 from Mr O R Nicholson, Orthopaedic Surgeon.
He referred to the injury to the right arm in 1974 that Mr Thomas told him about. He also referred to the 1989 accident.
He referred to Mr Thomas having been referred to Mr Tonkin. In March 1991 Mr Tonkin advised the extensor origin release for the tennis elbow symptoms and a limited wrist fusion for the wrist symptoms. This operation was not proceeded with within the time limit and a further application was made on 18 June 1991. This was not proceeded with, Mr Nicholson recorded that Mr Thomas stated that this was cancelled by ACC as it was felt he was working. Mr Nicholson discussed matters with Mr Tonkin who told him that Mr Thomas did not go ahead and the assumption was that he did not feel able to pay the additional costs involved.
Mr Nicholson said the right wrist was fractured in 1974. The fracture of the lower end of the radius had united in a position of slightly backward tilting of the articular surface and there was evidence of an ununited fracture of the ulna styloid.
He said there was no doubt that there had been a considerable strain placed on the arm in December 1989. The symptoms in the elbow were consistent with the diagnosis of a strain of the extensor muscle origin. In addition a strain to the wrist was sustained.
There is a photocopy on file of the patient’s own report as to the state of his arm and there is then a C11 request for private hospital costs dated 10 March 1992 put in by Dr Martin Rees, applying for private hospital costs approval. He applied for Items 373 x 2 and items 111,113,115 and 116 plus anaesthetist, theatre and bed charges.
There is a report on file from Mr Rees dated 4 March 1991 in which he describes the Xray findings. He describes the wrist as being grossly unstable as a result of the two accidents. Mr Thomas had a wrist which was functionally useless for heavy work but a normal range of movement for light work. However his wrist was inadequate for computer and keyboard work.
The Corporation considered the matter and wrote its letter of 24 April 1992.
Application for Review : On 4 May 1992 Miss Carhart made an application for review of the decision on Mr Thomas behalf stating that treatment was required to restore him to his earning capacity.
The Corporation administratively reviewed the matter but decided that, as it believed Mr Thomas was clearly capable of working, the decision should not be changed and the matter came to hearing.
Review Hearing : The matter before me at the review hearing was the decision in the Corporation’s letter of 24 April 1992 and accordingly I was not able to hear extensive evidence on nor am I in a position to make a decision on the Corporations’ decision in its letter of 28 April 1992 relating to the cessation of earnings related compensation. Ms Carhart would have preferred to have had both heard at once.
However, some evidence about Mr Thomas’ activity since the 1989 accident was given in order for me to be able to make this decision on private hospital treatment costs.
Nr Thomas told me that he was originally employed as an engineering manager and then an employee. His work was primarily the design of packaging machinery using a computer. He did this for 7 or 8 years. It involved the use of the keyboard using both hands and the use of a mouse using the right hand. Fine movements were required using the mouse – it was not simply a matter of poking it at the screen and moving it around in a fairly large way but being absolutely precise. His hand and arm had to be used in tension. He told me that he worked at Trigon Plastics and design sessions could last 16 hours. Now he was able to do this kind of work for only half an hour.
I must say at this point that I gained the impression that Mr Thomas was at Trigon for the 7 or 8 years but I noted from the letter of 3 October 1990 that he was employed only from January to November 1989. This concerns me as it makes me wonder whether this kind of work was Mr Thomas principal economic activity. Mr Thomas seems constantly to be having such misunderstandings.
It was also necessary for him to lift machinery once it had been made and to assist in the assembly of it. The parts were expensive and could weigh about 20 kg.
He submitted that he could not go back to this kind of work because his wrist was not stable enough and his arm was not strong enough.
He said he had his own computer equipment and had tried to keep using it for letters and so on but there was a 15 minute time limit on how long he could work without pain.
There was then evidence given at the hearing that Mr Thomas was not working in 1990 when the Corporation said he was.
Reference was made to the consultation with Mr Brownlee. It was submitted that Mr Brownlee applied for private hospital treatment costs himself but Mr Thomas did not know that he had applied and approval had been given, and that that first C11 approval lapsed.
He then went back to his own doctor and was referred to Mr Tonkin.
Whereas Mr Brownlee was going to do only the elbow, Mr Tonkin was going to operate on his elbow and wrist.
Submissions were made that the first approval to Mr Tonkin in April 1991 had been allowed to overrun by one week which was a technical lapse and that Mr Tonkin did not apply to extend that approval. Instead he reapplied all over again.
Mr Thomas said he had the money to pay the extra that ACC would not cover and it was a question of the hospital booking when Mr Tonkin could operate.
Submissions were made that Mr Rees, who Mr Thomas on balance now preferred to do the operation, had discovered the true nature of the problem without having to operate whereas Mr Tonkin was going to do a preliminary exploratory procedure and then operate further if necessary on the wrist once that had been done in theatre.
Mr Thomas was told that the total cost would be in excess of $4,000.00 and my understanding is that the approved amounts as per the Schedule for the surgical procedures are in the vicinity of $2,500.00.
Considerations : At the review hearing I indicated that I would give my approval to the payment of private hospital costs as applied for by Mr Rees. I did so because I had reached the conclusion on the basis of the evidence given to me on oath that, whether or not Mr Thomas was working or capable or working in the way that the corporation said he was [and I make no comment on that matter here], it was clear to me that to restore him to his principal economic activity which involves extensive use of computers, these operations need to be carried out. The Regulations require that for the costs to be paid the procedures are necessary for the due restoration of the claimant to his principal economic activity. I note on the other hand Dr Rees does not guarantee success.
I also note from the evidence that the doctors accept that Mr Thomas did injure his wrist in 1974 and he told me that was in about October 1974. He said all the records of that injury have been lost. There is no reason why one should not accept that earlier accident took place but, in any event, it is quite clear that both the elbow and the aggravation of the wrist injury were the result of the accident in December 1989.
It is plain from the file that the Corporation has grown very suspicious of Mr Thomas and, to put the best light on a convoluted history, that communication breakdowns have arisen.
However I do not believe that things have changed so much on the basis of the evidence that I was given, as far as computer work is concerned, between the time of the approval for Mr Tonkin to do the surgery in April 1991 and March 1992 when Mr Rees applied, that approval should not be withheld.
Decision : Accordingly the application for review is successful subject to the regulatory cash limits. It relates only to the letter of 24 April 1992, in respect of Mr Rees’ application. I understand that Ms Carhart is going approach the Corporation with a proposal about the difference between the amount that can be paid as per the Schedules towards the operation and associated costs and the total amount payable. The difference seems to be about $1500.00 perhaps more and I recommend that, if it is possible to do so, Miss Carhart’s requests be agreed to so that the operation can be carried out, paid for in full, and mr Thomas restored to a state where he can return to his main line of work.
I award legal costs of $500.00 and travel costs to the hearing of $20.00
R M CARTER
REVIEW OFFICER
Signed
Date of Decision 15 July 1992

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