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No Entitlement To Independence Allowance?

#1 User is offline   Dollie 

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  Posted 12 May 2007 - 09:02 AM

Hi all
I am posting for my partner who is a tetraplegic of 20 years. In 1987 when his accident occured, he was assessed as having a 100% disability and given the full lump sum. This was $27,000 to cover permanent loss or impairment of bodily function and for loss of enjoyment of life. We thought he would have some entitlement to Independence allowance weekly payments due to the fact that he is suffering long term problems (headaches, bladder, bowel etc) due to his disability. However, we were told by ACC that he has already been assessed as 100% back in 1987 (and paid out) so has no entitlement now.

Does anyone know if what we were told was completely true, or if there is any other kind of compensation for ongoing injury related problems due to disability? It doesn't seem right that so little money was paid out and expected to cover so much loss.

Kind regards
Dollie
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#2 Guest_mini_*

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Posted 12 May 2007 - 11:41 AM

I would say they are right unfortunately for you.

It might help to know that now-a-days you can not get weekly Independence Payments.

For some of us when lump sum was discontinued back in July 1999 we get quarterly payments of IA. It would take forever and a day to reach the $27,000 mark. Around 27 years in my case.

But then I am not 100% incapacitated.

If you cannot get anything more from ACC you may be able to get ongoing support thru disability allowance from WINZ (depending on your income) or something thru the health dept.

Try all avenues as time has passed and systems changed. It would be interesting to know how long they expected that lump sum to keep someone with a 100% disability, with the costs as they are today.

Seems unreal that it could be for life. You need to do some research, sorry cant help more.

Good Luck
Mini
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#3 User is offline   Dollie 

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Posted 12 May 2007 - 11:55 AM

Hi Mini
Thanks for your reply. I will keep researching but may need to go down a different avenue.

Kind regards
Dollie
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#4 User is offline   Alan Thomas 

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Posted 12 May 2007 - 12:11 PM

Dollie you need to keep account of all costs incurred relating to the injury and recover those. Any expenditure that occurs that is related to the injury cannot be covered by the taxpayer except on a temporary basis until such time as the ACC meeting its liability. Make sure you distinguish the difference between the purpose of lump sum payments, which was at that time for "pain and suffering and loss of enjoyment of life" and other entitlements. Social rehabilitation is additional to restore life back to the pre injury circumstance which is nothing to do with the lump sums.

The lump sum paid 100% as at it was under that act is one thing but if the original accident has resulted in additional accidents being caused resulting in additional injuries in a brand-new claim should be submitted for those new injuries and claim lump sums under the current act. This will give you another bite at the cherry.

In addition there will be many costs under the social rehabilitation section to assist living as normal a life as is practicable. In reality this can be many hundreds of thousands of dollars. How far have you got with social rehabilitation entitlements?
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#5 User is offline   Dollie 

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Posted 12 May 2007 - 01:35 PM

Thank you for your reply,
Yes there are several injuries that have occurred due to the original accident and claims have been lodged with ACC, but we didn't know about being able to get a lump sum or an independence allowance for these. We will follow up on this.

As far a social rehab goes, my partner is receiving attendant care and home help, and has received a payment towards a car in 2003 (and previous vehicles). He has also had technology assessments in the past, in which a computer and software was purchased to address his written communication needs.

I understand that the lump sum pay out and the social rehab policy are for different purposes . However, neither the lump sum payment or the social rehab policy take into consideration the wear and tear on shoulders, spine (scoliosis) or continuous problems with bladder and bowel that has been a result of injury over time.


Kind regards
Dollie
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Posted 12 May 2007 - 02:09 PM

Dollie

Maybe "Mental caused by Physical" assessment, for the on-going discomfort etc.

As all pain affects us mentally.

Get cover for that, then go for IA on that % plus the 'other' injuries as Alan says.

Go for it!
Mini
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#7 User is offline   doppelganger 

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Posted 12 May 2007 - 04:47 PM

The sad news is that you will not get independence allowance or another lump sum. Simple reason.

Any new injury that is calculated tested and assessed will come up with a figure. These figures will be added together and that will be your new level of incapacity.

The new level (in this case it doesn't matter what level it is) will have the 100% subtracted from it. they will take another 10% off it and leave you with a figure that will be in the minus. Legislation at the time of your husbands lump sum assessment put all persons with a similar injury as yours at 100% When it was brought into law it was a reasonable figure to collect. It was enough to pay for a house so the amount has not kept up with inflation.


You might want to look and see if he is receiving everything that he should. Are you being paid for being a career or has ACC not got around to that yet.

Welcome to the board.
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#8 User is offline   Alan Thomas 

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Posted 12 May 2007 - 05:04 PM

Dollie I spent many long hours on the telephone persuading a woman in your circumstance not to drive her car at the top of ACC case managers. This very distressed woman, and rightly so, had become distressed to looking after her tetraplegia husband to the extent that she had injured herself on quite a number of occasions. She also failed to carry to term 3very difficult to conceive babies which I suspect was the overriding factor in her desire for vengeance. I suspect that she was suffering from some form of trauma which is not strictly speaking a mental disorder in the same way as PTSD is not a mental disorder.

Dopplegangger has raised some important points that need to be checked out properly directly from the legislation perhaps with the assistance of a person qualified to provide reliable legal opinion. Either I am right or he is right. I suspect I might be wrong.

Given the probability that your husband has not received sufficient assistance to the extent that you have been called upon to do things beyond your capacity and may have injured yourself in the process then the question must be asked if that is the case have you lost the claim for your injuries? I would find it difficult to believe that over the years you have not already injured yourself or that you won't in the future given the ACC's historical niggardly approach to social rehabilitation funding.
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#9 User is offline   Dollie 

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Posted 14 May 2007 - 07:07 AM

Thank you all for your replies, I feel a lot more informed than I was.
I may have confused things a little, I personally don't have any injuries due to caring for my partner. All the injuries I stated refer to my partner. My concern is for the fact that he continues to suffer from on-going problems due to his original injury and after reading all comments it looks like he will not be entitled to IA (for that injury). We will definately check out IA for the other injuries.

Thanks again, it was much appreciated.
Dollie
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#10 User is offline   doppelganger 

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Posted 14 May 2007 - 08:21 PM

Dolly here is the legislation

Independence Allowance
441 INDEPENDENCE ALLOWANCE
(1) Subsection (2) applies to—
(a) A person to whom section 27(1) of the Accident Rehabilitation and Compensation Insurance Amendment Act (No. 2) 1996 applies and who was not reassessed under section 54A of the Accident Rehabilitation and Compensation Insurance Act 1992 before 1 July 1999:
(B) A person who, immediately before 1 July 1999, was receiving or was entitled to receive an independence allowance under section 54 of the Accident Rehabilitation and Compensation Insurance Act 1992:
© A person who suffered a personal injury before 1 July 1999 and did not apply for an independence allowance before 1 July 1999.
[S 441(1) amended by No 66 of 1999, s 3(1), by substituting in para © “apply for an independence allowance before 1 July 1999” for “claim an independence allowance”; effective 1 July 1999.]
(2) Such a person is entitled to receive an independence allowance on and after 1 July 1999 under Part 4 of Schedule 1, as modified by—
(a) Subsection (3); and
(B) Section 442(2)(a) and (B), if the person is a person to whom section 442(2) applies.
[S 441(2) amended by No 66 of 1999, s 3(2), by substituting “by—” for “by this section” and inserting para (a) and (B); effective 1 July 1999.]
(3) The modifications made by this subsection are as follows:
(a) Such a person may not lodge a claim for an independence allowance under Part 4 of Schedule 1 for any injuries suffered before 1 July 1999:
(B) A person described in subsection (1)(a) receives the rate of independence allowance payable on 30 June 1997 as adjusted by section 71 of the Accident Rehabilitation and Compensation Insurance Act 1992 or section 460:
© Any assessment under clause 60 of Schedule 1, or reassessment under clause 61 of Schedule 1, must be done on the basis of whole-person impairment for the combined effect of all his or her personal injuries covered by the former Acts, and only 1 independence allowance is payable for all those injuries:
(d) As soon as practicable after 1 July 1999 the manager must require a person described in subsection (1)(a) to be reassessed in accordance with paragraph ©.
[S 441(3) amended by No 66 of 1999, s 3(3), by inserting “made by this subsection”; effective 1 July 1999.]
442 ENTITLEMENT TO INDEPENDENCE ALLOWANCE OF PERSONS WHO RECEIVED LUMP SUMS UNDER FORMER ACTS AND SUFFER FURTHER IMPAIRMENT
(1) Subsection (2) applies to a person who received a payment for personal injury by accident under section 119 of the Accident Compensation Act 1972 or section 78 of the Accident Compensation Act 1982.
[S 442(1) substituted by No 66 of 1999, s 3(4), effective 1 July 1999. Former s 442(1) read:
"(1) Subsection (2) applies to a person who—
(a) Suffered personal injury by accident within the meaning of the Accident Compensation Act 1972 or the Accident Compensation Act 1982 before 1 July 1992; and
(B) Received a payment for the personal injury under section 119 of the Accident Compensation Act 1972 or section 78 of the Accident Compensation Act 1982; and
© On or after 1 July 1992 suffered an increased degree of permanent loss or impairment of bodily function resulting from the personal injury.”]
(2) Such a person may apply under section 441 for an independence allowance under Part 4 of Schedule 1. That Part applies subject to the following modifications:
(a) The independence allowance must be calculated by deducting, from any whole-person impairment assessed under clause 60 of Schedule 1, or reassessed under clause 61 of Schedule 1, any percentage permanent loss or impairment of bodily function for which any payment was made under section 119 of the Accident Compensation Act 1972 or section 78 of the Accident Compensation Act 1982:
(B) An independence allowance payable as the result of an assessment under clause 60 of Schedule 1 is payable from the date of the application for it.
[S 442(2) amended by No 66 of 1999, s 3(5), (6) and (7), by (i) inserting “under section 441”; (ii) substituting in para (a) “clause 60 of Schedule 1, or reassessed under clause 61 of Schedule 1” for “Part 4 of Schedule 1”; and (iii) substituting para (B); effective 1 July 1999. Former para (B) read:
"(B) The independence allowance is payable from the date of the application for it.”]

PART 4 — INDEPENDENCE ALLOWANCE
58 Independence allowance
58(1) The insurer is liable to pay the insured an independence allowance at the rate set in clause 62, if—
(a) The insured has suffered personal injury for which he or she has cover; and
(B) An assessment carried out under clause 60 establishes that that personal injury, for which the insured lodged the claim for cover, has resulted in a degree of whole-person impairment of 10% or more,—
but this subclause is subject to subclause (2).
58(2) The insurer is not liable to pay the insured any amount of independence allowance in excess of 100% whole-person impairment for mental injuries—
(a) That he or she has cover for under section 40; but
(B) That together are over 100% whole-person impairment.
59 Insurer not to assess entitlement until it receives medical certificate as to stability of insured’s condition
59(1) The insurer must not assess the insured's entitlement to an independence allowance until the earlier of the following:
(a) The insurer receives a certificate from a registered medical practitioner indicating that—
(i) The insured's condition resulting from the personal injury has stabilised; and
(ii) It is likely that there is impairment resulting from the personal injury; or
(B) After 52 weeks have passed since the date of the personal injury, the insurer receives a certificate from a registered medical practitioner indicating that—
(i) The insured's condition resulting from the personal injury has not stabilised; but
(ii) It is likely that there is impairment resulting from the personal injury.
59(2) The insurer is liable to pay for the reasonable costs associated with the provision of a certificate under subclause (1).
60 Assessment of entitlement to independence allowance
60(1) The insurer must appoint, and pay, as many assessors as it considers necessary to do assessments under this clause.
60(2) An assessor assesses the insured's s percentage of whole-person impairment arising from each claim that is referred to the assessor for assessment.
60(3) An assessor must do the assessment after the insurer receives a certificate under clause 59(1).
60(4) In doing an assessment under this clause, an assessor must—
(a) Use the American Medical Association Guides to the Evaluation of Permanent Impairment (Fourth Edition) (subject to any regulations made under section 403(2)); and
(B) Exclude from the assessment any impairment that does not result from the personal injury for which the insured lodged the claim for cover.
60(5) The insurer must notify the insured of—
(a) The assessed degree of whole-person impairment; and
(B) The rate of independence allowance payable, if any.
60(6) The insurer must pay the reasonable costs associated with the assessment.
61 Reassessment of entitlement to independence allowance
61(1) Clauses 58 to 60 apply to reassessments under this clause.
61(2) The insurer must arrange for an assessor to reassess an insured if—
(a) The insured was assessed after the insurer received a certificate under clause 59(1)(B) and before the insurer received a certificate under clause 59(1)(a); and
(B) The insurer then receives a certificate under clause 59(1)(a).
A reassessment under this subclause is not a reassessment for the purposes of subclause (4) or subclause (6).
61(3) The insurer must arrange for an assessor to reassess an insured who produces to the insurer a certificate from a registered medical practitioner indicating that the insured's impairment may have increased since the date of assessment, but this subclause is subject to subclause (4).
61(4) An insured is not entitled to more than 1 reassessment under subclause (3) in any 12 month period.
61(5) The insurer must arrange for an assessor to reassess an insured if the insurer has a certificate from a registered medical practitioner indicating that the insured's impairment may have decreased since the date of assessment, but this subclause is subject to subclause (6).
61(6) An insured is not required to undergo more than l reassessment under subclause (5) in any 5 year period.
62 Weekly rates of independence allowance
62(1) An independence allowance is payable at the weekly rates set out in the following table:
62(2) The amounts specified in subclause (1) must be adjusted in the manner provided in section 103.
63 Payment of independence allowance
The following provisions apply to the payment of an independence allowance:
(a) The insurer is not liable to pay an independence allowance for any period before 1 July 1992:
(B) The insurer is liable to pay the independence allowance on and from the date on which the insured lodged the claim for cover for the personal injury from which the impairment results:
© The insurer is liable to pay the independence allowance quarterly in advance for any period after the completion of the assessment of the degree of impairment:
(d) The insurer must not take any action to recover the whole or any part of a quarterly payment of an independence allowance in respect of a quarter in which—
(i) The insured's impairment decreases; or
(ii) The insured's entitlement to an independence allowance ceases:
(e) An adjustment to the level of entitlement of the independence allowance necessitated by a reassessment under clause 61 takes effect on and from the date of the next quarterly payment:
(f) The insured's entitlement to an independence allowance he or she was receiving at the date of his or her death ceases on that date.


notice that once you are at 100% can't go any further.

Here is ACC own guidelines on the IA.

Take note about page 12.

Tell me what you are looking for and I and others may be able to help. Are you looking for more income to help with stuff that ACC hasn't supplied or something.

Remember that ACC has the policy to remove entitlements so that they all get pay rises and then put it on TV that they supply entitlements with out even getting a request for them.. your case is not an actor playing what is the legislation, but real all in the name of efficiently.
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#11 User is offline   doppelganger 

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Posted 15 May 2007 - 06:03 PM

Can't post it but if you want a copy PM me with an Email address and I'll send it for you. It is on ACC web site as AMA 4 Guide Lines.
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#12 User is offline   Cedarpuss 

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Posted 12 March 2008 - 11:21 PM

View PostAlan Thomas, on May 12 2007, 01:11 PM, said:

Dollie you need to keep account of all costs incurred relating to the injury and recover those. Any expenditure that occurs that is related to the injury cannot be covered by the taxpayer except on a temporary basis until such time as the ACC meeting its liability. Make sure you distinguish the difference between the purpose of lump sum payments, which was at that time for "pain and suffering and loss of enjoyment of life" and other entitlements. Social rehabilitation is additional to restore life back to the pre injury circumstance which is nothing to do with the lump sums.

The lump sum paid 100% as at it was under that act is one thing but if the original accident has resulted in additional accidents being caused resulting in additional injuries in a brand-new claim should be submitted for those new injuries and claim lump sums under the current act. This will give you another bite at the cherry.

In addition there will be many costs under the social rehabilitation section to assist living as normal a life as is practicable. In reality this can be many hundreds of thousands of dollars. How far have you got with social rehabilitation entitlements?



It would depend on when those other injuries occurred as to which Act they fall under and therefore whether they'd be subject to the 92 or the 2001 Act. You may find the 100% already paid may need to be deducted and hence no further entitlement. If additional injuries are a consequence of the original injury they're treated as a duplicate of the original and therefore not a new accident (and not a fresh "bite of the cherry"). Still, worth a try though, if you don't qualify for and IA or LS you may at least get medical expenses reimbursed. I would have thought though, given his condition, that he'd be being case managed already, and therefore receiving all manner of other enitilements. If this is not so I'd suggest contacting your nearest Branch. Good luck, be firm.
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#13 User is offline   doppelganger 

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Posted 13 March 2008 - 11:07 AM

One of the other entitlements that Dollie is entitled to is being paid for looking after her partner. this would give you the freedom to have earnings because the ACC is not paying for the rehabilitation that ACC is liable for.
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