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Independence Allowence Delay's in the processing of claims

#1 User is offline   doppelganger 

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Posted 28 May 2005 - 08:03 PM

From some one not on the board.

I have been asked to post something about what is happening when people are applying for there independence allowance. Claimants are being given poor service from the Dunedin processing centre where it seems ACC are claiming that there is a great back log in Independence Allowances, Claimants are been sent letters advising of 6 to 8 week delays in processing of the Independence Allowance, and are told if ACC forgets about the application to contact them after a few months

Now the corporation can use section 57 to delay making a decision on the independence. Section 57 (3) gives the corporation instructions on what should happen during the 2 month period.

Section 58 explains what happens if the corporation has not made a decision. My interpretation would see that is that you would receive 100% of the independence allowance and if the ACC wants to reduce it they would have to take it to review
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I have my papers for my IA and this could prove to be very entertaining as the corporation has only obtained 4 medical reports in the 24 years of my injury. Only the first medical showed the injury while the other three examined me for the healed part of the injury (broken boned mended with out a problem).
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#2 User is offline   Dozens 

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Posted 30 May 2005 - 04:56 PM

It’s Interesting because I applied for an Independent Allowance in April this year for a sensitive claim I put in in 2001. Now I was told more than once that there was at least a 6-8 month waiting list to see an assessor. Well tomorrow I am having my assessment done so its only been just over one months wait. I wonder why I am been seen so quickly when before they said there was a 6-8 month wait??
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#3 User is offline   DARRELLGEMMA 

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Posted 14 February 2007 - 09:53 AM

View PostDozens, on May 30 2005, 05:56 PM, said:

It’s Interesting because I applied for an Independent Allowance in April this year for a sensitive claim I put in in 2001. Now I was told more than once that there was at least a 6-8 month waiting list to see an assessor. Well tomorrow I am having my assessment done so its only been just over one months wait. I wonder why I am been seen so quickly when before they said there was a 6-8 month wait??

Acc only have a limited number of assessors for sensitive claims & there is a limited number to physical claims. If acc had done the job properly tthen this problem would not have occurred. Disappointing indeed. The ama guides are not used in england & yet they can issue dodgy decisions perhaps we should adopt the english policy & not the American policy. If acc cannot get more doctors trained up then there are problems that are serious enough to warrant a judicial review in the high court. I was told by acc that it would be 6-8 weeks before they could assess me to long a delay to this assessment. There are regulations in place that say if acc cause the delays there is review rights available i would contact drsl as soon as possible. I also believe that the acc statutes & regulations do not say that the claimant/s have to be seen by acc trained assessors it is acc policy that says that then perhaps the acc should apply the acc policies to regulations or statutes because all entitlements are protected by statute & cannot be revoked in any particular way.
All The Best
Regards.
Darrell Pearce.
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#4 Guest_tspinoza_*

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Posted 14 February 2007 - 02:27 PM

May I suggest that if your claim for Independence Allowance appears to be taking too long that you apply for a review on the grounds of unreasonable delay?



If upheld - there is clear legislation and case law that applies - the Reviewer may then direct that a decision be made within a specific timeframe even, sometimes, making the decision on behalf of ACC.



I have found that such applications rarely reach a hearing as the Corporation, in its initial processing of the review application, then sorts things out and the claim proceeds in a timely fashion.



Sensitive claim applications invariably take too long (good going Dozens) and ACC staff are well aware of this.



I strongly recommend anyone who feels they have been waiting UNREASONABLY for a decision of cover or to an entitlement files an unreasonable delay application.



They are an excellent tool.
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#5 User is offline   Alan Thomas 

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Posted 14 February 2007 - 06:35 PM

tspinoza
John Greene who claims to be the top reviewer in New Zealand has made a decision that a delay of process to an independence allowance decision cannot be processed under part five of the act as there has not been a decision from which a delay has arisen.

He also claims that a failure to fund transport to earn from PTSD treatment on account of inebriating medication that prevents driving is an administrative decision that cannot be reviewed as only entitlement decisions are reviewable, even the delay in process from a decision.

John Greene has made a Review Hearing decisions that clearly state that has that you are referring to do not exist in legislation. Are you right or is he right? Comments anybody!
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#6 User is offline   doppelganger 

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Posted 14 February 2007 - 06:55 PM

when I look at the Act it is clear that it is clear what can be reviewed.

134.Who may apply for review—

(1)A claimant may apply to the Corporation for a review of—

(a)any of its decisions on the claim:

(b)any delay in processing the claim for entitlement that the claimant believes is an unreasonable delay:

©any of its decisions under the Code on a complaint by the claimant.

[(1A)However, a decision of the Corporation regarding the exercise of discretion under section 68(3) is not reviewable under Part 5.]

(2)An employer may apply to the Corporation for a review of its decision that a claimant's injury is a work-related personal injury suffered during employment with that employer.

(3)An employer may not apply to the Corporation for a review of a decision about the entitlements that have been or are to be provided to a claimant who has cover for a work-related personal injury.

(4)Repealed.

(5)A levy payer may apply to the Corporation for a review of a determination under section 209(1) or a decision referred to in section 236(1).

Cf 1998 No 114 s 135

and decision or Corporations decision.

``decision'' or ``Corporation's decision'' includes all or any of the following decisions by the Corporation:

(a)a decision whether or not a claimant has cover:

(B)a decision about the classification of the personal injury a claimant has suffered (for example, a work-related personal injury or a motor vehicle injury):

©a decision whether or not the Corporation will provide any entitlements to a claimant:

(d)a decision about which entitlements the Corporation will provide to a claimant:

(e)a decision about the level of any entitlements to be provided:

(f)a decision relating to the levy payable by a particular levy payer:

(g)a decision made under the Code about a claimant's complaint


In your case Allan I would se that the administrative decision was covered under ©, (d), (e)

In each case they are reviewable.

Mr Green made a new decision that should be able to be reviewed or taken to court.

I can not see where a reviewer can make such a decision on something that is not being reviewed.


145.Review decisions: substance—

(1)In making a decision on the review, the reviewer must—
(a)put aside the Corporation's decision and look at the matter afresh on the basis of the information provided at the review; and
(b)put aside the policy and procedure followed by the Corporation and decide the matter only on the basis of its substantive merits under this Act.

(2)However, on the review of a decision revised by the Corporation under section 65(1), the Corporation must establish that the decision revised under that subsection was made in error.

(3)The reviewer must—
(a)dismiss the application; or
(b)modify the Corporation's decision; or
©quash the Corporation's decision; or
(d)direct the Corporation to make a decision within a time frame specified by the reviewer if the Corporation has not made the decision in a timely manner as contemplated by sections 54 and 134(1)(B); or
(e)make the decision for the Corporation if it has not made a decision in a timely manner as contemplated by sections 54 and 134(1)(B).

(4)If the reviewer quashes the Corporation's decision, the reviewer must—
(a)substitute the reviewer's decision for that of the Corporation; or
(b)require the Corporation to make the decision again in accordance with directions the reviewer gives.

(5)The reviewer may make a decision even though a person entitled to be present and heard at the hearing did not attend it unless, before the reviewer makes the decision,—
(a)the person gives the reviewer a reasonable excuse for the person's non-attendance; and
(b)the reviewer considers that a decision should not be made until the person has been heard.
Cf 1998 No 114 s 148
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#7 User is offline   Alan Thomas 

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Posted 14 February 2007 - 07:59 PM

The starting point would be along the lines that if the government takes our right to sue away from us when replacing that right with the ACC and then takes away our rights of judicial remedy we have become second-class citizens capable of achieving refugee status and 10 other countries in the world that accepts refugees.

The land of liberty, the USA, is very interested in this issue of global workers insurance.

My first instinct is that part five of the act does provide legal remedy in the ACC fails to make decisions for its own pecuniary advantage. Claiming an error and then taking advantage of the error is no excuse, especially when the error as planned even if it is to employ stupid people and not providing training so as to guarantee errors.
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#8 Guest_tspinoza_*

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Posted 15 February 2007 - 09:35 AM

Alan Thomas if John Greene has really done this then it should have been taken to appeal as the legislation, as doppelganger quotes it, is really quite clear.



Can you provide us with more specific details as to what John Greene opined, please?



Whoever is right however, he or I, I can assure you that, as a strategy to reach a decision it is very, very effective.



As more of an aside, but equally interesting, can you give any reference as to John Greene claiming to be the ‘top’ reviewer in the country?



It may be amusing to drop that, if you can provide substantiation, into conversation with other reviewers – I sort of gathered they consider themselves to be independent and equal.



I would look forward to their response so please, do post it.
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#9 User is offline   Alan Thomas 

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Posted 15 February 2007 - 10:04 AM

John Green and did not give an opinion he made a judicial decision. He agreed with the ACC lawyer.

I don't think you have got the point of this circumstance. The ACC simply failed to make a decision, there was an unreasonable delay to make the decision. John Greene judgment was that a Review Hearing application cannot be heard by a reviewer if there is no decision from which a delay occurred so if the ACC failed to make a decision there can never be an appeal apparently temporising the entitlement forever.

As the reviewer claims that he has no jurisdiction he does not actually make a decision about the substantive issues from which any future appeal could be made.

With regard to the ranking system of reviewers. Reviewers are ranked and categorised by the ACC in accordance with their specialty. The ACC also rank and categorised review hearing applications and depending on type match them with the reviewer of their choice.

Two reviewers, one of them John Greene, still have a warrant to make decisions on the pre-1992 legislation. Of those two John Greene claims to be the superior placing him as the most superior reviewer in New Zealand. This information is contained in several review hearing recordings of which in due course I will receive transcripts.

I will however agree that reviewers are not equal. As to whether or not they are independent you only need to determine whether or not they have sought legal advice regarding decisions. Apparently they are requiring legal advice from the ACC Legal Services Unit who also consider themselves separate from the ACC even though they are the instructing solicitors to the ACC barrister going before the reviewer. Intrigued, you ought to be.
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#10 User is offline   gaffa09 

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Posted 15 February 2007 - 10:24 AM

to allen and tspinoze

If this helps .
Under Jan Whites instruction and my belief that Jan White employed the top Reviewer in NZ,
I was appointed John Greene to review my whole case from day one , From My accident in 1977,
I have had one meeting for 4 hours back in Sept last ,
My next meeting is this Sat the 17th for aprox another 4 hours .

My understanding from Jan White and what i lead to believe that John Greene is the tops in NZ.
Our first meeting was successful in my views.
But i am not holding my breath with the second meeting .
this could be interesting , My stress levels are very high in fact on boiling point .
and if i don;t get results it will be the high court .
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#11 Guest_tspinoza_*

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Posted 15 February 2007 - 04:46 PM

A review on the grounds of unreasonable delay is clearly available under the legislation. It has also been available 'in fact' as I have successfully filed any number of such applications.

It is wrong of members, a mistake of fact, disadvantaging readers, to advise that it is not available.

On the other hand if accforum readers do not wish to take advantage of that pathway, even imagine it does not exist, well that's their right.

But why complain about any unreasonable delay if you are not going to use the processes available to sort such delays out?
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#12 User is offline   Alan Thomas 

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Posted 15 February 2007 - 05:01 PM

tspinza
You did not explain whether an appeal could be against a delay to make a decision or a delay to process the decision.

Mr Greene makes review hearing decisions on the basis that you cannot have a right to a review hearing regarding a delay of process unless the delay is the processing of the actual decision that has previously occurred and not the delay to actually make a decision.

Can you please explain the difference
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#13 Guest_tspinoza_*

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Posted 15 February 2007 - 07:48 PM

No, you still have it wrong – the unreasonable delay is in making the actual decision whether it be of cover or entitlements.

There must be a decision 'pending', something that is properly able to be had and has been requested – usually via ACC 45, ACC 18, written request, even clear recommendation by an assessor although I like to write and specifically request such items again 'for the avoidance of doubt'.

If it is a decision for cover or entitlements then it can be expected within the statutory time frame (cover) or in a reasonable (a little grey but I have found Reviewers pretty good at assessing what is reasonable in such matters) length of time.

The providing of the entitlement, if delayed, may well mean writing a specific request for its provision and then giving it, I recommend, 21 days and applying for the unreasonable delay review.

To sum up, the delay in making the decision is what is able to be taken to review and is an avenue well worth considering when facing such delays.


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#14 User is offline   Alan Thomas 

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Posted 15 February 2007 - 08:33 PM

tspinza
I am not disagreeing with you I am only saying what Mr Greene states.
I am not talking about the acceptance of cover from an ACC45 form. I am talking about virtually every other request for an entitlement, supported by substantial facts such as specialist medical reports etc that has not received a decision. I'm talking about when the ACC simply ignores the claimant. Many applications for cover and entitlements are accepted but never processed so as to provide the entitlements.
You have still not addressed the issue. If you do not understand the issue I would be happy to explain further because this circumstance effects most of the people on this forum.
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#15 User is offline   Spacecadet 

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  Posted 15 February 2007 - 09:00 PM

Alan
You are absolutely correct. My experience is that ACC accept a claim, within the required timeframe, to comply with the Act; in my case section 57. From that point on they frustrated my every attempt to claim entitlements - to the extent I paid my own specialist and private hospital fees to get off the DHB waiting list - on the advice from a doctor I would be dead within a year unless something was done about my condition. I now have no more money to continue private treatment, and still ACC procrastinate. Its called ignorance!
Is this acceptable?
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#16 User is offline   DARRELLGEMMA 

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Posted 15 February 2007 - 09:15 PM

View PostSpacecadet, on Feb 15 2007, 10:00 PM, said:

Alan
You are absolutely correct. My experience is that ACC accept a claim, within the required timeframe, to comply with the Act; in my case section 57. From that point on they frustrated my every attempt to claim entitlements - to the extent I paid my own specialist and private hospital fees to get off the DHB waiting list - on the advice from a doctor I would be dead within a year unless something was done about my condition. I now have no more money to continue private treatment, and still ACC procrastinate. Its called ignorance!
Is this acceptable?

Evening spacecadet it is not acceptable for acc to say pay the surgery yourself it is there responsibility to help claimants back into rehabilitation. It even happened to me after acc could not decide if surgery is required to stabilise the knee or what ever injury has been accepted by acc as far as i am aware if they accept the claim they have to obtain a medical assessment to see if the injury is stable & permanent & has a whole person impairment to be entitled to any form of compensation.
Regards.
Darrell Pearce.
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#17 Guest_tspinoza_*

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Posted 16 February 2007 - 08:06 AM

Alan Thomas writes:



“Many applications for cover and entitlements are accepted but never processed so as to provide the entitlements.



You have still not addressed the issue. If you do not understand the issue I would be happy to explain further because this circumstance effects most of the people on this forum.”



I worry here that I am going to now get widely abused for ‘advertising’ but I cannot see how else to positively and usefully respond.



I invite anyone whose cover is accepted and whose request for an entitlement has never been processed – that is the request has been made but no decision given in reply - or the request has been agreed to but never actioned to contact (PM) me.



Should they meet the criteria (see S 134 of the Act see Doppelganger’s post above) I am happy to assist them to review that unreasonable delay at no end cost to themselves.



In the meantime, those who keep maintaining that one cannot have an unreasonable delay reviewed should take the time to read the Act:



S134. (1)A claimant may apply to the Corporation for a review of—

(b)any delay in processing the claim for entitlement that the claimant believes is an unreasonable delay.



Denying this is giving advice that is wrong in law (read what it says) and wrong in fact (I have seen numerous such applications succeed).
















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#18 Guest_mini_*

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Posted 16 February 2007 - 08:33 AM

Hi everyone

This started with Independence allowance and the time taken. I will backtrack a bit to that.

Does anyone know if 'Mental' is a 'sensitive' claim.

I have recently (like last month) been covered for this.

Apparently Dunedin are 'snowed under' so I have had a reply from 'Hamilton'.

That was more than 21 days ago and it was acknowledging receipt of my Application.

Am I to believe from postings that it is time to give them a bell and find out what is going on at least??

I 'feel' that it is long enough to have got the wheels into motion. Like are they just going to assess the 'Mental' and tag it onto the Physical or are they going to use the very detailed psychiatrict report to make a decision of % therefore $??

About the 'timeliness' issues aand what sections of the act used. Dopple and Tpinoza are correct in what they say. Even though the end result maybe only another extended time limited to ACC, a Review is certainly a way to get them moving, although, I noted to my horror in Court that, if ACC go outside the Reviewers time limit again, you can only Review again. This is for any 'entitlement' and is what Warren and Blurb are up against.

The lack of Decision could actually go on and on and on like a merry go round for 'entitlement' since the 2001 Act came into force and 'separated' 'cover' and 'entitlement' and 'deemed decisions'. It is just another way our rights have been eroded, through suptle changes in the Acts.

Although mine got sorted in the end, it meant I had to take more action than I would have liked and put lots of pressure on with multiply cases going at the one time. It doesn't leave much time for 'rehabilitation'.

Cheers All
Mini
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#19 User is offline   Alan Thomas 

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Posted 16 February 2007 - 09:34 AM

Mini
there are two categories of mental injury from which you could claim. One type of mental injury is PTSD. PTSD could be from:
criminal sexual abuse resulting in the mental injury PTSD.
The trauma of an accident event injury resulting in a mental injury, also PTSD.

tspinza
you still do seem to understand that Mr Greene is talking about.
S134 (1) (B) refers to a delay in process of the decision after it's been made. In other words for example deciding to give you some ERC but to delay the calculation of your correct ERC but never getting round to making the calculation.

The best way to advertise how clever you are is to answer the question. If you can answer this question I might even want to become your customer. But am not interested in your just telling me that you are clever. If you do not understand the question or do not know the answer to the question then that's okay that just demonstrates the limits of your competency as an advocate, no harm done.
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#20 Guest_mini_*

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Posted 16 February 2007 - 01:00 PM

Thanks Alan

My Mental is not PTSD. That is clearly stated in the psychiatrist report. It was not an injury sustained at the same time as my physical injury, it was caused after by factors including operations and the loss of my job.

The Dr said the 'duration' of the mental injury with no treatment made it permanent and stable!!! Like ACC should have been assisting me to hold onto my job, instead of me having to pay mega-bucks to lawyers to do that for me.

The state of my phsyical and issueing mental lead to me having to retire!!

My case sounds quite unique as I havent heard of others without 'brain injury' or as you say PTSD, getting 'cover', for this 'trauma' we all know we face.

Maybe someone can shed some light on this for me and also how the % WPI = $ is worked out for mental. I really have no idea what to expect.

On other note: your reply to Tipnoza is exactly what happened to me after I had asked for backdated weekly compensation.

The story was that 'cover' was established and 'incapacity' was established but only part of w/c was going to be paid as they needed extra documentation and time to calculate further entitlement!!!???

Twisting words to suit themselves. I beleive they had simply ran out of time that was noted by us all to be the date in which they would have me a 'decision'.

Then the Reviewer simply turned around and gave them 'extra time anyway, this effectively cut out any chance of 'interest', as they had not collected all documentation to make calulation and payment!!!

Cheers Mini
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