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Reduction in % impairment Power of peer reviewers

#1 User is offline   castor 

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Posted 21 September 2008 - 03:24 AM

Hi,

After 8 months of my IA being processed by ACC I've finally recieved the final impairment levels for my sensitive claim - 40% total impairment, 20% apportioned to other factors, 15% historic and 5% lump sum.

While it's good to FINALLY have a result out of this, I can't understand how they derived at this figure. ACC initally sent the information to the assessor without indicating that I was to be assessed for both IA and lump sum, so for 7 months they worked on it just being an IA claim. It went through months of peer review etc. Finally they got it back from peer review for the team leader to pick up on the need to look at a lump sum as well...

At this point it went back to the assessor to be reallocated, he decided - 50% total impairment, 16% apportioned to other factors, 21% historic and 13% lump sum. I was verbally told this over the phone and was confirmed when I asked to see all the reports related to my case - funnily enough the claim manager was not too keen on sending out this report.

From reading the peer review report after these figures were submitted by the assessor, it seems that the peer reviewer couldn't see how I could be 50% impaired in total and still be working. For this reason alone the numbers had to be reduced. Considering I've been sectioned under the Mental Health Act on a Friday, managed to be released from the sectioning and turned up to work on Monday as if nothing had happened, that excuse is a bit hard to take.

Has anyone else had a change in numbers which has increased the proportion of the overall impairment to the other factors?
I'm not strong enough to fight this to any extent. I might be strong enough to question it, but these final %'s have really affected me badly - childhood secrets were entrusted to this assessing psychiatrist and on an emotional level it feels very much as if those secrets were not believed - just as the abusers said they wouldn't be. On an intellectual level I know that ACC is out to save money and minimise where possible, trying really hard to hold onto that belief.

Any advice from others who have had their numbers change so drastically would be appreciated.
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#2 User is offline   doppelganger 

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Posted 22 September 2008 - 01:26 PM

Hi caster and welcome.

not sure how to help you here as really need more information


15% historic . is this fron a previous assessment ?

20% apportioned to other factors, Are these other factors nothing to do with an injury?

I think that you reall need a avocate here especially with the Mental injury.You are dealing with the mind set of Dr P....... who has the impression that injured are better off with out any help.

taking so long might have been something to do with the case managers remuneration.
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#3 User is offline   castor 

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Posted 22 September 2008 - 02:02 PM

Hi :)

Thanks for the response...

I realise after reading through what I wrote a 3:30 in the morning, that it wasn't quite as understandable as I thought :blink:

The "historic" is what they have determined as my IA entitlement. They consider the 20% apportioned to other matters as being nothing to do with the injury/abuse - parental neglect, borderline tendencies etc. What is interesting is that I read another persons post here in another thread and the wording they were given was almost an exact replica of the wording I got. The only exception is that I told my assessor that I had been tested for Borderline Personality Disorder and had not met the criteria, so he knew he couldn't use that exact wording. My assessment was in Hamilton, her's in Wellington.

I was told that the delay was because of the "wording of the diagnosis" - the first peer reviewer talked to the assessor, the ACC funded psychiatrist that I was seeing on a monthly basis and a DATA assessor I saw over a year ago to try and find a diagnosis. However, there wasn't any indication of the diagnosis in either report.

The only difference between the two reports, as far as I can tell, is the changes in the percentages for apportionment. In some respects I wouldn't have been so suspicious if it hadn't been for the rather drastic changes in the % of the overall that it went to.
So in the first report -
Total impairment 50%
Apportioned to other factors 16% (32% of overall impairment)
Independence allowance 21% (42% of overall impairment)
Lump sum 13% (26% of overall impairment)

In the final report -
Total impairment 40%
Apportioned to other factors 20% (50% of overall impairment)
Independence allowance 15% (37.5% of overall impairment)
Lump sum 5% (12.5% of overall impairment)

So by saying that I'm working, not only did the overall amount reduce by 10% impairment, but the amount apportioned to each area changed drastically e.g. other factors went from 32% to 50% of overall impairment. I can't see how that happened.

To make things even more fun, this afternoon I'm having to go to ANOTHER assessment (DATA one this time). My faith in psychiatrists was pretty low to begin with, but this has shaken even that :(

I can't afford any legal representation as I've just come out of a very messy and expensive divorce, so I came here to see if anyone else had any advice or experienced a similar playing with their percentages.

Thanks
Castor
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#4 User is offline   redsquare74ucys 

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Posted 22 September 2008 - 09:57 PM

Wonder if that was one of my posts that you read? (Assessed 55, rounded down to 50, deducted 50% for "other factors".....). I too feel really screwed by the psych/+gp. Such a lonely feeling.

Sorry to hear about your divorce - wow that's a tough time you're having there! I'm going through a lawyer, John Millar under legal aid for the ACC stuff. I think you have to pay it back if you can.

Disheartening to read that most likely I will have to go through another assessment. Had my last one back in Janurary and have only just recovered from the ordeal. God, is any of this worth it? I'm hanging in there, just. Flipping out entirely every now and then for variety. Am on an Invalids Benefit which is helpful, but does nothing for my self esteem or isolation.

BPD was one of the excuse they used for me.
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#5 User is offline   castor 

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Posted 23 September 2008 - 09:30 AM

View Postredsquare74ucys, on Sep 22 2008, 09:57 PM, said:

Wonder if that was one of my posts that you read? (Assessed 55, rounded down to 50, deducted 50% for "other factors".....). I too feel really screwed by the psych/+gp. Such a lonely feeling.


Hi,

Yes it was your post that I read. Obviously they must have a standard wording for each potential area to apportion the overall percentage too. Makes sense that they would have a standard wording which has been approved by their legal team. It just struck me as being odd.

The assessment I had yesterday was because I receive ACC funded counseling, so they have to do assessments every so often to check whether there has been an improvement or whether there is any other support that can be given. Thankfully the clinical psychologist I'm seeing at the moment talked to the psychiatrist prior to me arriving, so it was a pretty easy assessment. So unless you're getting ACC funded therapy you won't need to do a DATA assessment.

What I've found so disturbing about the whole process is the time taken and the obviously random way in which the final percentages were apportioned. I'm not that memorable, so how could the psychiatrist make an accurate apportionment when he'd seen me for just 90 minutes 8 months ago?? There are factual errors in the report which indicated that the notes he took weren't all that accurate.

On Thursday the clinical psychologist I'm seeing is going to have a look at the report and see about reporting the factual errors. Will see what she says about the apportionment changes - she already indicated that she thought the overall percentages were too low...

Take care of yourself :)
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#6 User is offline   redsquare74ucys 

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Posted 23 September 2008 - 10:24 PM

Quote

The assessment I had yesterday was because I receive ACC funded counseling, so they have to do assessments every so often to check whether there has been an improvement or whether there is any other support that can be given.


?? I keep asking them what other support can be given and I get ignored. Guess you have to cost them money in treatments to get that kind of thing.

ATB with your assessment with the psych.
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#7 User is offline   castor 

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Posted 24 September 2008 - 08:59 AM

View Postredsquare74ucys, on Sep 23 2008, 10:24 PM, said:

?? I keep asking them what other support can be given and I get ignored. Guess you have to cost them money in treatments to get that kind of thing.

ATB with your assessment with the psych.


Hi and thanks...

I've had the DATA and psychiatric assessments described to me as being a check on the therapist and their work as much as anything else. Gives the client a chance to have a say about what is happening. However, because I have such problems with authority I always see it as them testing me and my level of "craziness".

ACC Sensitive Claims only recognise some therapies and counsellors, so unless you find one that does "conventional" therapy as well as "alternative" therapy, you're options will be pretty limited. In Hamilton there is just a problem finding an ACC accredited therapist. Most up here are sick of the ACC system so stop doing the ACC work. There are all sorts of problems with ACC not paying the therapists on time etc.

Take care
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#8 User is offline   Phoeniks 

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Posted 24 September 2008 - 11:39 AM

View Postcastor, on Sep 24 2008, 08:59 AM, said:

Hi and thanks...

I've had the DATA and psychiatric assessments described to me as being a check on the therapist and their work as much as anything else. Gives the client a chance to have a say about what is happening. However, because I have such problems with authority I always see it as them testing me and my level of "craziness".

ACC Sensitive Claims only recognise some therapies and counsellors, so unless you find one that does "conventional" therapy as well as "alternative" therapy, you're options will be pretty limited. In Hamilton there is just a problem finding an ACC accredited therapist. Most up here are sick of the ACC system so stop doing the ACC work. There are all sorts of problems with ACC not paying the therapists on time etc.

Take care

Hi Castor, good clinical psychologist in Hamilton is Veronika Isler. You've already got one by the sounds of it but its sad that even the good therapists get to a point whereby they would be shooting themselves in the foot if they were to help you take on the ACC monster. I have a huge problem with authority also trust issues, like you, and wouldn't it be fantastic if we didn't need to question the ACC system which IMHO just exacerbates already present issues? How did you get around being assessed by a gp instead of psychiatrist? Did you have to request it and make it happen? Which psychiatrist did you see? I'm interested because I am in the tron and I have asessment coming up soon. Take care, Phoeniks
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#9 User is offline   castor 

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Posted 24 September 2008 - 04:37 PM

View PostPhoeniks, on Sep 24 2008, 11:39 AM, said:

Hi Castor, good clinical psychologist in Hamilton is Veronika Isler. You've already got one by the sounds of it but its sad that even the good therapists get to a point whereby they would be shooting themselves in the foot if they were to help you take on the ACC monster. I have a huge problem with authority also trust issues, like you, and wouldn't it be fantastic if we didn't need to question the ACC system which IMHO just exacerbates already present issues? How did you get around being assessed by a gp instead of psychiatrist? Did you have to request it and make it happen? Which psychiatrist did you see? I'm interested because I am in the tron and I have asessment coming up soon. Take care, Phoeniks


Hi Phoeniks,

I'm seeing Christine Vorster at the moment (clin psyc), she's been really good so far. Asking what would be really difficult questions in a way that makes you think with minimal triggering. I usually see another therapist, but asked to see a clin psyc to try and learn some more coping skills. Only got a few appointments left with her, so am in the process of deciding what I want to do - go back to the other therapist or give therapy a break for awhile.

I saw a psychiatrist for the IA/Lump Sum assessment. He is in charge of one of the in-patient units at Henry Bennett (Psyc Unit in Ham Hospital), so it was really triggering being assessed by him, let alone the questions he asked - he didn't even have the full abuse history so ended the assessment by asking me to list them :( He's made quite a few errors in the report as well, mind you not as bad as the guy they had come down from Auckland to assess me who said in the report that I had two children, when I've actually had two cats at the time. I was wondering if "parental stress" would make it onto the list of other factors affecting the apportionment, but it didn't :rolleyes:

Yeah the whole ACC thing just makes all the trust issues worse and causes further victimisation. In many ways I wish I'd never applied for the IA. It seemed like a good idea at the time, but I now realise that I wasn't strong enough for it. I don't want to put anyone else off applying for it, but just to make sure you're strong and/or have good support around you when going through it.

I've yet to come across any excellent psyc's. But I saw Dr Peter Dean on a monthly basis through ACC and he was a bit of a laugh and up-front. One day there was a HUGE roach under his calender which made me dissociate and he didn't even blink an eye. I've been in assessments through the Crisis Assessment Team where the supervising psychiatrist has kicked the training registrar out of the room because he was triggering me and causing dissociation and all sorts of problems without even being aware of it...

Feel free to message me with the name of the psyc you've been referred to if you don't want to mention it in the open forum and I'll let you know if I've come across them.

Take care
Castor
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#10 User is offline   castor 

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Posted 25 September 2008 - 12:13 PM

Hi,

Thanks for the listening ear that has been provided in this forum... It has been appreciated.

I saw the clinical psychologist this morning and she wasn't impressed with the peer review process or the final result. While I discussed with her that I'm not strong enough to go through a mediation process, she thinks that there needs to be letters sent to indicate the errors. She's going to write a letter stating the reasons why I am able to work and still be 50% impaired - that is, it's the only thing that keeps this mind in one piece; and that the original report is a more accurate indication of my functional levels. Was kinda funny, she's this rather reserved lady in manner and she was reading through the report repeatedly saying "But how can they do that...????"

I'm also going to write to correct the errors and indicate why I think the first report should be upheld.

The way the clin psyc mentioned the peer reviewers name, it sounded like she knew of her - but that might be just my over-sensitive interpretation.

Will let you know if I get any response from ACC.

Castor
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#11 User is offline   doppelganger 

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Posted 25 September 2008 - 02:48 PM

Good on you and you provider.

I am only guessing who the peer reviewer was and in doing so is thinking that it is Dr P.

Dr P is a GP with no specilised area. he has been in the ACC system for over 10 years

A good letter from you with a good advocate will over rule a GP. there is case law onthis already. Use an advocate if ACC won't issue a revised decision.
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#12 User is offline   castor 

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Posted 25 September 2008 - 09:17 PM

View Postdoppelganger, on Sep 25 2008, 02:48 PM, said:

I am only guessing who the peer reviewer was and in doing so is thinking that it is Dr P.


Hi,

No it wasn't the Dr you mention, but a Dr R who is a child and adult psychiatrist who forced the numbers down. Funnily enough it was Dr P who bowed to the assessors clinical knowledge as a specialist psychiatrist and agreed with the first round of figures - go figure, in my case I would have been better off with his peer review.

Are claiments allowed access to their entire file? I just would like to know the correspondence that occured with the first peer reviewer and the other psychiatrists that he was meant to have contacted. I'd also like to know what response, if any the assessing psychiatrist made to all of this.

Take care
Castor
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#13 User is offline   castor 

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Posted 26 September 2008 - 12:55 PM

View Postcastor, on Sep 25 2008, 09:17 PM, said:

Are claiments allowed access to their entire file? I just would like to know the correspondence that occured with the first peer reviewer and the other psychiatrists that he was meant to have contacted. I'd also like to know what response, if any the assessing psychiatrist made to all of this.


Found the letter in another part of the forum B)
*Note to self - look before asking*

Thanks again for the help :)
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#14 User is offline   redsquare74ucys 

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Posted 26 September 2008 - 10:05 PM

Hi Castor,

FYI found someone helpful at ACC who has advised the psych report (the one where they assess your injury as stabilised or not) is important as it states what injuries have been accepted for cover. [Note that in my case three events were originally accepted, two featured in the psych report, and then in the next report one of those is swapped for the one missing. So may be more important for me?? Who knows]

Glad to hear you have someone backing you with the going back to work thing.

ATB
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