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#1 User is offline   freefallnz 

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Posted 06 June 2005 - 03:30 PM

On my most recent Initial Medical Report the Learned Medical Professional wote.

“You have provided for my information the documents as outlined in your schedule of documents. This was both adequate and appropriate for the purpose of carrying out an Initial Medical Assessment.”

Strangely enough The schedule of Documents is inaccurate and the ACC also appeared to have forgotten to include several other medical reports.

I have of course asked the learned Medical Professional to clarify his statement.

1 . Would Dr .... agree that an assessing physician requires a complete patient history including all medical reports as well as specialist reports i.e. physiotherapy, occupational therapy, psychological and psychiatric reports to be supplied to the assessing physician before reviewing a patients case and making any diagnosis or recommendations on the basis of reasonable medical certainty.

2. Is it now accepted practice that medical assessors accept as adequate and appropriate a compendium of reports from the ACC and do not require a complete documented medical history?

I am of course waiting with anticipation for the learned Medical Specialists answers…

I do know of one instance when a learned medical specialist referred a patient for enhanced radiological examination. Unfortunately an ACC case manager had deliberately omitted the patient’s medical history, which included a severe allergy to Iodine. Can you imagine that patients agonising death as the Iodine dye blistered and boiled away the patients entire venous system. *

Of course I already have a third unasked question. Basically what qualifications would be appropriate to enable an ACC case Manager to reliably bowdlerize a claimant’s file? – Logically that answer is a medical degree.

Which led to this strange flight of Fancy! Well it is raining outside, the TV died on friday night & some stupid bastard cut my SKIL Saw lead in half so I can’t play downstairs either .

One of the failings of the present ACC system is that Injury and rehabilitation Cases are managed by “qualified” and occasionally well meaning clerks. It is readily apparent that the present case management system is unwieldy and open to mistake and abuse.

Obviously case managers are always going to be making mistakes when interpreting medical information and the legal requirements of the ACC Act. One just has to look at the unwieldy systems that the Minister & ACC has put in place in an attempt to rectify the sad situation i.e.
  • 1. The review process. And the detrimental effect that this has on Injury Sufferers. For example patients are continually being denied rehabilitation and treatment for injuries and that by the time a “case managers” decision has been reviewed and appealed years have sometimes been lost before rehabilitation can begin.
  • 2. The ACC approved provider scheme; which appears to have been introduced to provide patients with a choice of qualified service and treatment providers.

As I see it one of ACC’s jobs is to provide treatment and rehabilitation in order to return a patient to “work” as quickly and as economically as possible. Obviously it is costing the ACC & the patient considerably (both financially & physically) when delays in treatment or rehabilitation caused by faulty case management practices are experienced.

I also see that is the job of both the Minister & the Management of ACC’s responsibility to oversee the system and as part of that oversight to identify problems and flaws in the system in order to be as fiscally responsible as is possible.

Which brings me back to this!

Logically the most qualified person managing a claimants case and rehabilitation on a day-to-day, basis is the patients own Doctor. So I would suggest that the Patient’s primary ACC case manager should be the patient’s own GP.

It is obvious that the GP is working in a relatively efficient and proven system already, i.e. the medical system.

For example a Doctor when faced with a problem or requirement outside of his particular area of expertise is capable of identifying the patients needs & will refer a patient to the appropriate service or specialist e.g physiotherapy, oncology, orthopaedic’s, obstetrics.

By removing the need for a third unqualified party to second guess every decision, recommendation and referral made by the GP; the delays, inefficiencies and mistakes of the present faulty and inadequate case management system would be negated allowing for a much speedier recovery and less costly resolution for both ACC and the patient.

Obviously the present review system would then be redundant resulting in immediate and considerable savings to both the ACC and patient.

Not as obvious but I would suggest that there would no longer be a need for ACC approved providers & assessors.

I would hate to suggest that an industry has grown over the last few years catering solely to the ACC's base requirements. It is however, apparent that some ACC approved providers will only provide the minimum of a service required which although not detrimental to a patient’s rehabilitation and recovery are often less efficient & effective.

Simply removing the compliance costs of being an ACC approved provider and using the established medical and rehabilitation systems already in place would result in savings for the provider and consequently in savings to the ACC.

Simple patient choice would then see the less effective and efficient providers disappear from the market place.

It is an acknowledged fact by ACC that the present case management system is overworked and understaffed and that existing case managers have too heavy a caseload. Obviously the case managers are extremely stressed and consequently more prone to making mistakes.

By returning Primary case management to a patient’s GP, ACC would effectively remove the possibility of mistakes and inherent injustices in an overworked, inefficient and fault ridden system resulting again in huge savings, for both the ACC and the patient.

Such savings I suggest would be substantial and should over time result in both cheaper employer and earner levies.

I can only see the above suggestions as a Win Win situation for the entire ACC system, patient, taxpayer and the country in general.

Of course there would be loud squeals of discontent from those glutting themselves at the ACC trough and some job losses. I am however sure that some of the more suitably qualified profesionals & case managers could go on to develop meaningful careers in telephone sanitization or canine excrement collection.

* FYI. The patient didn’t die. Although severely brain damaged the patient adamantly refused too allow the procedure and became hysterical about it. Carefully and sympathetic questioning by the staff eventually revealed the patients knowledge of an allergy to iodine, which was tested with a simple skin swab! The radiographer immediately cancelled the enhanced radiological exam. As for the assertion that ACC deliberately withheld the medical records. There used to be a post about ACC double stamping files… Well the patients medical history noting iodine allergies had been double stamped and withheld from the consulting specialists.
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#2 User is offline   Juscallin1 

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Posted 06 June 2005 - 04:04 PM

Hi Freefallnz.
We all know the perfect world would be the GP following thru the patient's progress towards returning to work.

However, ACC have trained the Case managers to "Actively challenge all Gp decisions". That is straight from an ex-case Manager!

You are right about the years of delay, deny and claimants then pass the point of no return while trying to take erroneous decisions to Review, appeal etc.

There is a huge growth industry of shonky toady ACC Assessors who recieve a marvellous income for writing false reports. And as you say, never look at Xray and scan results. Have no idea how to interpret a scan and dont want to.
These felons are the root of the whole matter. Everyone in NZ should boycott them and then ACC will HAVE to have a think about someone honest?!
What is the answer? not money that is for sure!!!
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#3 User is offline   doppelganger 

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Posted 06 June 2005 - 07:05 PM

Of cause there is an industry built around the Act there is a way to kill that indusry but it needs time and effort,

This is your rehabilitation in the enclosed file.

Freefallnz request another medical with all the information supplied. write to the specialist directly and request the same under the privacy Act.

Complaint to there complaints office, there fraud unit, and a copy to the police,

make the ACC staff work for there dollars

Attached File(s)


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#4 User is offline   freefallnz 

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Posted 06 June 2005 - 08:16 PM

The answer and I’m sure it would be achievable and much more cost effective would be to completely reorient the ACC into a purely funding and adminstrative service. E.g. collection, organisation and disbursement..

The intent of ACC was originally to provide cover for injured people on a no fault basis.

One could say that fault has by now been firmly established. i.e. differential industry levies and the motor vehicle fund. I would hazard a guess however and state that industry is probably better off paying the ACC differential levies than were they to try to carry comprehensive insurance for all possible liabilities.

I believe that one of the major problems with the ACC system is that it equates itself to an insurance system.

As I hypothesised before the crux of the issue would be too place the ACC claimants case management into the GP’s hands.

Now don’t for one minute, think I’m a proponent of having ACC claimants administered by WINZ however take a look at the WINZ system.

Basically WINZ relies on GP’s to monitor & maintain Sickness and Invalid beneficiaries. WINZ just does the necessary background work. It neither approves nor disapproves the medical requirements and interventions as managed by the GP’s.

Procedure wise WINZ beneficiaries still have to provide medical certificates on a agreed schedule i.e. 3 monthly for recipients of the sickness benefit (Initial Injuries) and anywhere from 2-5 years for recipients of the invalids benefit (Serious Injuries)

What could be simpler.

In comparison the ACC system immediately falls over in the respect that every decision made by a GP is scrutinised and either approved, disapproved or amended by Case Managers. It is at this point that problems arise. Unqualified or semi-qualified case managers are making decisions on legal and medical issues of which they have at best a poor understanding.

I believe that the situation only worsens from this point. Sure there is a review system in place which can be carried through too the Judicial System but I believe that this system is inherently prejudicial to the whole ACC system. It seems to be rooted back in the past to the adversarial system where claimants had to sue companies or individuals for compensation and the mindset appears to have continued through to today where a claimant has to prove fault and liability.

Decisions made at review and in the judicial system are more often than not based upon the semantics of an argument as opposed to the real world and the injuries, their consequences and effects.

As noted in a previous post ACC is now relying more and more upon lawyers to represent ACC. Combine this with huge cost of defending litigation within the Judicial system and it must be obvious that the current cost of administering ACC claims is ballooning out of all proportion.

ACC are still extremely lucky that 80% of claimants have not got the resources either physically, emotionally or financially to fight and contest unjust and often illegal ACC practices.

I think it would be an enlightening process were one to compare the numbers of staff and number of cases and the costs involved in such differing case management practices; between the ACC and the WINZ systems.

My answer change gear, change perspective, what ever.

Why not have ACC working for their clients

As Simply as possible Case Management should reside with the claimants GP.

Obviously a GP cannot be involved in the general administration of a claim so why not utilise the ACC as a helping hand peforming the administrative tasks as it does now.

ACC Case managers would not be involved in the decision making process.

The job of an ACC Case Manager would simply be to provide and organise the rehabilitation an other interventions (medical, social and vocational) as directed by the GP in conjunction with the Claimants rehabilitation Plan.

Clearly that would solve a lot problems all around.

Its not such a biggie afterall is it?

Ok such an approach would require a radical change in mindset amongst the powers that be and the pariahs feeding off the present system but is there not some truth on the old adage. Keep it Simple Stupid.
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#5 User is offline   doppelganger 

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Posted 07 June 2005 - 12:06 AM

freefallnz your points are noted. it is clear that you did not read that file that I left you to read. the Act still would need to changed. so that vocational rehabilitation could be obtained.

on the surface you ideas look good. bu when looking at the vocational rehabilitation it is a bit more than suply money Vocational rehabilitation must be active and have a goal that must leave he claimant in a position that is independent and finicially as well off as before the injury. 5 year university courses like the corporation supplied in the early 70 is not the answer. (great deal did not finish the course) Monoteringit would be hard but if the review process was reversed were the corporation applied for a review to decline the entitlement. this way the entitlement is obtained and it be only removed when it was proven that the entitlement is not apoximate or required.
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#6 User is offline   freefallnz 

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Posted 08 June 2005 - 09:54 AM

I think that the main point we both agree on is that the ACC Act requires a complete overhaul.

My point above is that the focus and objective of the current ACC scheme is off beam.

Vocational rehabilitation is just one of the problems that needs to be adressed. As it stands the Vocational Rehabilitation as is currently provided is a complete farce.

The ACC’s perception of vocational rehabilitation is only to ensure that any claimant has been provided with the minimum tools and “retraining” as a lip service to satisfying the requirements of the ACT during the exit process.

The only vocational training needs I have seen identified by ACC on claimant’s files have all been the same.

Basically a pre-employment course to enable a claimant to identify the jobs and training he would require in order to re-enter the work place.

Surely with the number of “experts” both vocational and medical that ACC has had assessing claimant’s needs over the years. At least one of them would have identified a real vocational skill as a requirement by now!

Has any claimant on this forum ever been identified as requiring anything more than a pre-employment course prior to a work trial?

Has anybody ever had realistic and meaningful vocational rehabilitation identified by an ACC “expert”?

I would agree that throwing money at a claimant’s case and offering unlimited training is senseless.

But hey claimants do have real needs and requirements and ACC by definition is now in the business of rehabilitation and should provide real vocational rehabilitation.

After all is not rehabilitation an ongoing intervention and the ACT by simplistically stating that 2 years of rehabilitation is sufficient is limiting and denying too claimants the necessary tools they require to return as much as possible to their pre-accident abilities.

For example it took five years for me to re-enter the workplace after my first serious injury.

But even by working within the current limitations of the Act; could not ACC identify the real vocational needs and offer claimants and prospective employers a few “incentives”. I.e. WINZ offer employers a 6 months subsidy to take on a certain category of beneficiaries.

Would it not be sensible for ACC to realistically identify and agree vocational training requirements and “cover” the claimant/employer’s training cost’s for vocational rehabilitation/training after they have re-entered the work place. Surely this would be of benefit to both the claimant and employer.

If by definition an “expert” is a drip under pressure. Then an ACC expert can only be defined as an Asinine crass & corrupt drip under pressure.
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#7 User is offline   magnacarta 

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Posted 08 June 2005 - 10:53 AM

freefallnz, I completely agree with you. But who is responsible for this fiasco???

Clearly, the ACC Board. Take a look at the Crown Entities Act 2004.

Note the sections dealing with the collective and individual responsibilities of Board members of statutory Crown agencies - which ACC is.

For example, s. 49 says that the board of a statutory entity must ensure that the entity acts in a manner consistent with its objectives, functions, current statement of intent, and output agreement (if any) under Part 4.

Section 50 is also very relevant in that the Board must ensure that it perfoms its functions efficiently and effectively and in a manner consistent with the spirit of service to the public.

Section 61 provides that board members may rely on reports, statements financial data and other information provided by employees and others.

BUT s.61 only applies if the ACC board members (3) (a) act in good faith AND (3) (B) makes proper inquiry if the need for inquiry is indicated.

And an inquiry is indicated by virtue of the contiuning and unresolved complaints about the ACC from claimants. Our request for an inquiry should now be directed at the ACC Board.

The Crown (Government) is only liable and financiallly exposed while the Corporation is acting within its mandate.

IMHO it is not - so the Board is collectively liable and financially exposed.
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#8 User is offline   doppelganger 

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Posted 08 June 2005 - 07:21 PM

Magnacarta; the board is there to administer the Act and must do that effectively. The Act is a piece of legislation to con the money from the public. (Putting it simply) t is the legislation and how it is written that is the problem.

The only time that you could get the board is if the board requested the changes in legislation to dis-entitle an entitlement. This would them become the above paragraph.

Freefallnz; Writing legislation is difficult as with the ACC legislation will be administered by some thick twits. You think that case managers are thick now, putting new legislation will expose the case managers practices and policy's that the next lot of case managers will need to be even thicker.

I agree that legislation needs to provide proper rehabilitation. The 2 years is a fast. Two years might be all right if your were just up skilling (as the Germans do ), but if there is a need for a total new occupation then that 2 years is rubbish. The corporation will try and use old court decisions to decide the level of rehabilitation entitlement if it is not written into the Act the level of rehabilitation is not stated.

The Germans have got it right
'Further training is linked to the profession that the injured person had been engagedor very difficult to perform as a result of the injury, to a more managerial in and helps him or her to switch over from a manual activity, that has become impossible or supervisory role (e.g. from bricklayer to foreman bricklayer).'
This was the intention of the first Act but the Idiots decided against this, blowing out the costs.
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#9 User is offline   freefallnz 

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Posted 08 June 2005 - 10:02 PM

Yup I've said from the beginning a simple 90 change in persective, focus and direction could change the ACC into the thoroughbred we'd all like to see.

However the small minds of the powers that be can never understand such a simple concept.

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#10 User is offline   MadMac 

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Posted 09 June 2005 - 09:51 PM

:D Whoa ...love the pictures and concept freefallnz ... mmmmm do we have to kiss the toad so it will turn into a princess ooops sorry in this case a horse.
Mind you some toads are full of disease's that if contact is made you would be infected ... living a painful sickening existance...
:D Have a great day ,got any more awesome pictures...a picture says a thousand words...
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#11 User is offline   magnacarta 

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Posted 09 June 2005 - 10:12 PM

Doppel, you have over-looked one important piece of the IPRC Act in Schedule 5 Clause 11 -

"Every decision validly taken at a meeting of the Board is a decision of the Corporation."

This means ACC Board policy which affects your entitlements or interests which then cascades down to the operational level (CEO/Staff).

The ACC Board retains its functions, duties and powers even though it may delegate to others. (Schedule 5, Clause 25)

It is the ACC Board who is liable and accountable.
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#12 User is offline   magnacarta 

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Posted 09 June 2005 - 10:17 PM

IW2, I agree. It is also covered in Schedule 5 Clause 19 of the IPRC Act.

There are therefore two Acts (possibly three i.e. Employment Relations Act) that the ACC Board and CEO Wilson seem to be breaching.
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#13 User is offline   Karney 

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Posted 10 June 2005 - 12:57 AM

Back to an earlier point - while I agree with a lot of the changes suggested for ACC (and Gawd knows it needs to change) I can see that handing case management over to GPs may not be completely problem free. GPs do have a vested interest in keeping their patients sweet so that they can continue to get their fees. If a big family all have the same GP and one of that family has an ACC claim but has genuinely fully recovered but doesnt want to go back to work, does the doctor dare to sign him/her off and risk losing the income from the entire family who may choose to change GP? It could happen and I'm sure some GPs now knowingly sign fraudulent ARC 18s. Plus some people really dont get on with their doctors.
The comment about the WINZ sickness benefit system being better - I've heard that WINZ are planning to start sending claimants to their own specialists for second opinions too.
I know I may be biased, having worked for ACC in the past, but case managers are supposed to have a tertiary education and health related qualifications such as nursing, physio, OT, etc, are common amongst case managers. Some I know have law degrees. They are not thick. The system is overly complicated and the ethos of the organisation prevents staff from doing the good job that many could accomplish if they had the autonomy to do so. The treatment providers are, on the whole, really competent and highly qualified people. But they are paid to provide minimum assistance and reports which give ACC the excuse to exit claimants. I've recently found out that many have a clause in their contracts that forbids them providing a private assessment for claimants who are challenging ACCs decisions. These guys are terrified of upsetting ACC in any way because their income and well being are as dependent on the corporation as our own is.
IW2 - it is illegal to discriminate against anyone on the basis of disability so if you want to apply for a job at ACC, dont let them stop you going for it - but honestly, why would you want to?!!!!
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#14 User is offline   magnacarta 

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Posted 10 June 2005 - 08:03 AM

Nelsonian you said -

"I know I may be biased, having worked for ACC in the past, but case managers are supposed to have a tertiary education and health related qualifications such as nursing, physio, OT, etc, are common amongst case managers. Some I know have law degrees. They are not thick. The system is overly complicated and the ethos of the organisation prevents staff from doing the good job that many could accomplish if they had the autonomy to do so."

The system has been made overly complicated by the ACC Board who sets the policies but that can be no excuse for the actions and omissions of case managers.

The defence "I was only following orders" was discredited at the Nazi Nuremberg Trials - and remains discredited.

Presumably, the staff have a Union which they could approach if the "ethos of the organisation" is preventing them from doing a good job that they could accomplish according to the law.

We don't see that happening.

The ACC Board is collectively liable and accountable because it is not acting in accordance wih its statutory mandate.

It is a statutory entity and legally operates as a governing Board at arms length from its Minister or shareholding Minister.
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#15 User is offline   Karney 

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Posted 12 June 2005 - 12:08 AM

I agree Magnacarta, but the case managers who want to be fair to claimants and provide the help they need end up leaving the corporation in disgust at the system. I guess staff can join a union but it certainly wasn't strongly unionised when I was there. Staff who contact politicians in an attempt to change things or whistle blow dont get anywhere - there are many in this forum who have had the same experience of no-one listening. So staff either leave or take on the beliefs of the corporation to survive.
Of course this doesnt excuse those people who are attracted to such jobs because they want to be in a position of power over others. And unfortunately there are plenty of those.
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#16 User is offline   freefallnz 

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Posted 12 June 2005 - 08:46 PM

Nelsonian,

True ACC Case Managers are supposed to be qualified.

At the start of this thread I stated..

"I do know of one instance when a learned medical specialist referred a patient for enhanced radiological examination. Unfortunately an ACC case manager had deliberately omitted the patient’s medical history, which included a severe allergy to Iodine. Can you imagine that patients agonising death as the Iodine dye blistered and boiled away the patients entire venous system."

The Qualified ACC Case Manager (DENTAL NURSE) double stamped some Medical records. Provided to ACC ASSESSORS only the single stamped copies! AND CAME CLOSE TO KILLING A CLIENT!

Would that have been Medical Misadventure or attempted murder???

And the fact that today ACC is now responsible for filing and administering Medical Misadventure claims is even more frightening!

I only feel sorry for all the Waikato ACC Clients who now have this "qualified" Dental Nurse overseeing case managers and f...king with their claims!

So no matter how qualified and intelligent an ACC Case manager is. I say that no lawyer or dental nurse is qualified to second guess or challenge a Medical GP's findings and should not be in a position where they can or even worse manipulate the system to support their own agendas!


Bring it on ACC!!
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#17 User is offline   doppelganger 

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Posted 12 June 2005 - 10:22 PM

I think that its in this document on about page 35 that lawyers have no place in making medical decision and judges often get medical decisions wrong

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#18 User is offline   MG 

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Posted 13 June 2005 - 10:21 AM

I think this publication, from the Occupational Physicians, is pretty self-serving. It seems to argue that, if people did not receive compensation for their injuries, they would be healthier. This is simply ridiculous. What drives poor health outcomes associated with compensation is the gruelling battle claimants have to endure before receiving compensation. They have to fight: insurers/ACC, doctors, lawyers, employers and a popular culture that says everyone receiving compensation is a bludger. IMHO, it's time to go back to the Woodhouse Principles of comprehansive, no fault compensation for personal injury.
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#19 User is offline   fairgo 

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Posted 13 June 2005 - 05:03 PM

Hear hear!
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#20 User is offline   doppelganger 

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Posted 13 June 2005 - 06:03 PM

M I took it to read that people that do not laim compensation for an injury are better off and heal quicker because they do not need to worry about the insurer. These GP are looking at a system that is floored in the recovery of injuries because of the intreferance from insurers, lawyers , and judges Case managers are the biggest problem in the full recovery system and this is because there aim is based on court cases and not rehabilitation.
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