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O'Malley v FPA (Insurer) DC 135/2009 suspension of entitlements/choice of assessor

#1 User is offline   Tattoo 

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Posted 20 August 2009 - 08:40 AM

http://www.acc.co.nz/PRD_EXT_CSMP/groups/e..._ctrb113332.pdf


Issue concerns the Insurer suspending entitlements because of the claimants failure to attend a medical assessment. At the heart of the issue is the claimant wishing to have a choice of assessor. The Judge found in favour of the claimant.

I quite like Judge Barber's second to last paragraph re claimants being human beings. This is probably at the heart of the Judge's decision.

Note: the legislation does not require the Insurer to provide a choice of assessor. However, it is the circumstances of this case that makes suspending entitlements unreasonable. Suggest the reader steps back and looks at and understands the circumstances and also read Section 72 (Rights and responsibilities of a claimant) before getting themselves in a compliance issue situation over attending a medical assessment.


Section 72 - Responsibilities of claimant who receives entitlement
(1) A claimant who receives any entitlement must, when reasonably required to do so by the Corporation,
(a) give the Corporation a certificate by a registered health professional or treatment provider that deals with the matters and contains the information that the Corporation requires:
(B) give the Corporation any other relevant information that the Corporation requires:
authorise the Corporation to obtain medical and other records that are or may be relevant to the claim:
(d) undergo assessment by a registered health professional specified by the Corporation, at the Corporation's expense:
(e) undergo assessment, at the Corporation's expense:
(f) co-operate with the Corporation in the development and implementation of an individual rehabilitation plan:
(g) undergo assessment of present and likely capabilities for the purposes of rehabilitation, at the Corporation's expense:
(h) participate in rehabilitation.
(2) Every such claimant must give the Corporation a statement in writing about any matters relating to the claimant's entitlement, or continuing entitlement, to an entitlement that the Corporation specifies, and must do so whenever the Corporation requires such a statement.
(3) If the Corporation requires the claimant to do so, the claimant must make the statement referred to in subsection (2) as a statutory declaration or in a form supplied by the Corporation.
Compare: 1998 No 114 s 115
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#2 User is offline   Southernman 

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Posted 20 August 2009 - 10:13 AM

Another ACC claimant refusing to see the infamous Dr Robb. I know of a claimant that went to see Dr Robb and he was drunk! In fact Dr Robb has a reputaion for such behavior around Loburn.
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