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Declined in an interesting way

#1 User is offline   underestimated 

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Posted 26 August 2019 - 04:45 PM

My claim went to review a second time.

The reviewer asked that I have a proper IMA report delivered by an Occupational Therapist (Fit for Work contracted by ACC themselves) regarding my ability to work prior to 2008. This report was to decide the outcome of my claim.

The ACC contracted Fit for Work OT wrote heavily in my favour and stated my ability to work would have been severely effected by the injury.

ACC then went to a Medical Adviser who wrote notes all over the top of the ACC contracted OT from Fit for Work.

My claim was declined again.

My lawyer requested another review, however made a point that the ACC medical adviser should not been made part of the decision the reviewer requested.

We are waiting on another review now.

I am not sure anyone can advise.. I rang Fairway and asked if there is a time frame for the review date to be decided... another thing I'd like to know.

If anyone can make an injury worse... it's hats off to ACC. This has been a very painful process. Each visit to the psychologists, psychiatrists and occupational therapists have been extremely traumatising (I've seen quite a list now). It does not get easier each time I talk about it. The memories remain the same and the hurt gets worse as time goes on. We can't turn back time.. undo what has been done.. but we can try and move forward. I have every right to ask for what is written in our legislation. I was injured.. that has not been declined. The early medical evidence is not being disputed. But it's very difficult moving forward while I have had to make these visits.


Saying that the good news is my lawyer says their team now has enough medical evidence to take this to court if needed and I do not have to revisit my injury in full detail to any doctors anymore.


I have left this claim in the hands of my lawyer.


It's been nearly an eight year battle now. I've kept it pretty quite. But reality is I'll probably be a name on a court list as I face ACC off. And that's what I am waiting for now.


I feel there has been an injustice but no doubt ACC will try and talk their way out of this too.


Anyone dealing with ACC I have full empathy for. It can be a truly life destroying experience dealing with ACC if they decide to play ball against you. Their strategy is waiting until the last minute before informing you of anything... setting up reviews or answering questions.


The medical evidence needed has been provided. Now I have every reason to be upset and feel I am being messed around.


:/


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#2 User is offline   Alan Thomas 

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Posted 26 August 2019 - 05:31 PM

View Postunderestimated, on 26 August 2019 - 04:45 PM, said:

My claim went to review a second time.

The reviewer asked that I have a proper IMA report delivered by an Occupational Therapist (Fit for Work contracted by ACC themselves) regarding my ability to work prior to 2008. This report was to decide the outcome of my claim.

The ACC contracted Fit for Work OT wrote heavily in my favour and stated my ability to work would have been severely effected by the injury.

ACC then went to a Medical Adviser who wrote notes all over the top of the ACC contracted OT from Fit for Work.

My claim was declined again.

My lawyer requested another review, however made a point that the ACC medical adviser should not been made part of the decision the reviewer requested.

We are waiting on another review now.

I am not sure anyone can advise.. I rang Fairway and asked if there is a time frame for the review date to be decided... another thing I'd like to know.

If anyone can make an injury worse... it's hats off to ACC.




As your claim for cover together with your own treatment providers assessment of your capacity to work has been decided by a qualified and registered medical doctor it it is not up to a therapist to challenge the doctor in any way or form. If the ACC want to challenge your doctor then they going to have to send you to someone of a higher qualification.

As for the ACC generating their own information in defiance of not only the legislation but also the reviewer, by way of an in-house doctor, that simply isn't permissible under the ACC legislation as the legislation require all such information to be independent of the ACC. That means the ACC cannot rely upon one of their own employees even if the employee as a contract worker. An independent assessor is mandatory.

What you will usually find is that ACC staff that have been given decision-making authority have never had any actual training with regards to the criteria of legislation. Instead ACC attending to rely upon fellow staff to help new staff members along in the form of a peer review type process along with company guidelines.

Lawyers and such like helping claimants should be challenging the individual staff member produced in the decision with regards to whether or not they were authorised by legislation to make the decision. This is necessary because of such stupidity we see.

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#3 User is offline   underestimated 

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Posted 26 August 2019 - 07:28 PM

"If the ACC want to challenge your doctor then they going to have to send you to someone of a higher qualification."


They did send me their own doctor of the highest qualification. The highest in the field. This was confirmed firstly by ACC complaints, my lawyer and then my psychologist who works for the current government inquiry of abuse. This is why my reviewer wanted the OT opinion to be clarified.

I am now wondering how ACC's liability can be counted on if they are confused on who to hire for opinion. I had no say in the matter as to who I saw. ACC chose this doctor. It seems more as if they did not like the opinion. I say this because ACC cut so many other independent medical specialists out of having a say if they do not meet ACC's regulations. Then they hire someone of all their own specific regulations and then decline that order.
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#4 User is offline   underestimated 

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Posted 26 August 2019 - 07:47 PM

"That means the ACC cannot rely upon one of their own employees even if the employee as a contract worker. An independent assessor is mandatory"

If independent is not counted and a firm contracted by ACC is not counted, then who is? Especially if the claimant is not allowed to choose a doctor?
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Posted 26 August 2019 - 08:54 PM

In my own opinion Thomas of course independent doctors opinions need to be taken seriously immediately. I'm 8 years through a battle.
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#6 User is offline   Alan Thomas 

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Posted 27 August 2019 - 11:02 AM

View Postunderestimated, on 26 August 2019 - 07:28 PM, said:

"If the ACC want to challenge your doctor then they going to have to send you to someone of a higher qualification."


They did send me their own doctor of the highest qualification. The highest in the field. This was confirmed firstly by ACC complaints, my lawyer and then my psychologist who works for the current government inquiry of abuse. This is why my reviewer wanted the OT opinion to be clarified.

I am now wondering how ACC's liability can be counted on if they are confused on who to hire for opinion. I had no say in the matter as to who I saw. ACC chose this doctor. It seems more as if they did not like the opinion. I say this because ACC cut so many other independent medical specialists out of having a say if they do not meet ACC's regulations. Then they hire someone of all their own specific regulations and then decline that order.


There is two elements to consider,

ACC must commission an independent opinion

That opinion must be superior to the information already provided



If the ACC do not follow these two fundamental principles the legislation requires them to rely upon the information already on file, from your own treatment provider.


In the event that the ACC make a decision on their own financial interest without following the legislated criteria it is a matter of disobedience to the legislation and therefore criminal fraud in the form of insurance fraud.
After all if a private insurance company were to do what the ACC had done your very quickly find that they would be locked up quick smart


it seems to me that the ACC seek to distance themselves from criminal liability by employing absolute morons and then not provide them with the necessary information so as they could claim ignorance and therefore them claim and criminal court that they have no evil mind and the commissioning of a crime

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#7 User is offline   Alan Thomas 

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Posted 27 August 2019 - 11:06 AM

View Postunderestimated, on 26 August 2019 - 07:47 PM, said:

"That means the ACC cannot rely upon one of their own employees even if the employee as a contract worker. An independent assessor is mandatory"

If independent is not counted and a firm contracted by ACC is not counted, then who is? Especially if the claimant is not allowed to choose a doctor?


Legislation requires the ACC to commission independent assessors. This means that they are not directly employed by the ACC and the ACC does not in any way or form influenced the decision.

So even when ACC do commission independent assessors the fraud still happens by way of the ACC not providing those assessors with all of the relevant information but rather selected information.

The claimant most certainly is not permitted in law to choose their own doctor for an independent assessment. That would not be independent now would and you would not want to be a kettle claiming the pot is black. You should welcome the most highly qualified medical professional to determine reality.

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#8 User is offline   Alan Thomas 

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Posted 27 August 2019 - 11:06 AM

View Postunderestimated, on 26 August 2019 - 08:54 PM, said:

In my own opinion Thomas of course independent doctors opinions need to be taken seriously immediately. I'm 8 years through a battle.


Perhaps you should consider a complaint with regards to the delay of process.
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Posted 27 August 2019 - 12:51 PM

View PostAlan Thomas, on 27 August 2019 - 11:06 AM, said:

Perhaps you should consider a complaint with regards to the delay of process.


Yeah.. ACC can wait 3 months to set up a review date. Amazing huh. I thought the time frame was shorter.. but there we go.
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