Wear and tear excuse to decline cover

[MSTRS]

I recall a post or two on this subject and have had a search to find them. No luck. Does anyone else recall the topic and can point me at the thread?
Basically, we all know that ACC is declining cover on this basis (eh Maha?) and I would like to see what % of claims it applies to compared with years previously.

[MSTRS]

Oh, and there was a series of posts about an ACC-appointed doctor in Dunedin dismissing claims too...

[sunhuntin]

i dont know where the posts are, but ive seen threads on trademe relating to people being declined. ive told an older co worker to refuse to carry heavy or awkward boxes upstairs due to this new "policy" as the two of us get used as the muscle.

[MSTRS]

Nobody?
The reason I ask is that some ACC flunky has had a letter to ed published, saying that they 'don't use tear and tear as an excuse to decline claims'
This needs to be countered with facts...

[Stickchick]

My Dad damaged his shoulder putting scaffolding up and got declined from ACC due to his age. They claim it is wear and tear due to his age and the fact that the older you are the more likely you are to damage yourself due to being brittle.

[duckonin]

Nobody?
The reason I ask is that some ACC flunky has had a letter to ed published, saying that they 'don't use tear and tear as an excuse to decline claims'
This needs to be countered with facts...

Try and make a claim for a joint if you are over 10years old, (ACC) will come up with a negative somewhere..

[firefighter]

My Dad damaged his shoulder putting scaffolding up and got declined from ACC due to his age. They claim it is wear and tear due to his age and the fact that the older you are the more likely you are to damage yourself due to being brittle.

You will win that if you contest it, it's descrimmination. I'd actually go straight to any media outlet that will listen over that, and they will probably grab that like a dog with a bone. "sorry elderly not entitled to ACC because you are brittle".

[firefighter]

My Dad damaged his shoulder putting scaffolding up and got declined from ACC due to his age. They claim it is wear and tear due to his age and the fact that the older you are the more likely you are to damage yourself due to being brittle.

You will win that if you contest it, it's descrimmination. I'd actually go straight to any media outlet that will listen over that, and they will probably grab that like a dog with a bone. "sorry elderly not entitled to ACC because you are brittle".

[MSTRS]

Thanks.
I know there are some 'horror' stories out there. What I'd really like is some figures...
Say year 2000 % claims denied w+t ... 2009 % claim denied w+t.
Or similar

[Sentox]

Probably already seen this, but: http://www.stuff.co.nz/national/health/3703720/Wear-and-tear-used-to-deny-ACC-claims

[firefighter]

Probably already seen this, but: http://www.stuff.co.nz/national/health/3703720/Wear-and-tear-used-to-deny-ACC-claims

I love that article. How the hell a 21 year old could have too much wear and tear is ludicrous. In fact, privatising ACC sounds better and better, at least you know you are covered.

When you think about the amount of ACC levys you pay a year from income, rego etc it's probably the same cost as private except you will be able to squeeze dental cover in there too.

[Ixion]

You will win that if you contest it, it's descrimmination. I'd actually go straight to any media outlet that will listen over that, and they will probably grab that like a dog with a bone. "sorry elderly not entitled to ACC because you are brittle".

It is not necessary to rely on a vague argument of discrimination.

There is abundant case law, around the very old legal rule called the "Eggshell Skull Rule". Which , in fine, says that if you negligently bump into an old lady, and she knocks her head, occasioning a blow which to a normal person would be of no consequence; but she happens to have an exceptionally fragile skull and suffers injury; you are liable, her thin skull is no defence.

Throw some case citations at her :

Mullins vs Gray 1999
Smith v. Leech Brain & Co. Ltd. (QB, 1962
Stephenson v. Waite Tileman Limited (NZ CA, 1973

Lots of others but those are good ones. The last is a NZ case
Smith vs Leech Brain covers the case of an injury aggravating an existing precondition.

But you do need to be aware of the counter, the "Crumbling Skull Rule". This covers the case where an injury brings to light a pre existing condition. And the injured persons condition is in fact due to the underlying condition , not the injury. So the ACC might say "You have indeed suffered injury. And that injury is made worse by a pre existing condition. We are liable for the cost of treating the injury itself, but not for the underlying degenerative condition"

To take an extreme instance, if I am knocked off my bike, suffering a severe laceration. ACC are liable for the cost of treatment of the laceration. But, in the course of cutting me open to treat the injury they , happenstance, discover that I have an unrelated cancer. ACC will be liable for the cost of treating the injury, but not the cancer (but note Smith vs Leech Brain where the injury CAUSED a cancer- which is covered).

[duckonin]

Thanks.
I know there are some 'horror' stories out there. What I'd really like is some figures...
Say year 2000 % claims denied w+t ... 2009 % claim denied w+t.
Or similar

Maybe go here and ask those that are involved with the system, rather than asking for figures and others subjective nonsence....http://accforum.org lot of info from real persons on there...

[MSTRS]

Link doesn't work.
I have 'heaps' of anecdotal evidence regarding individuals. That anecdotal evidence suggests that way more are being turned away. Or forced to take some sort of legal action.
I'd really like numbers...
But I don't know where to find them.

[Sentox]

I'd really like numbers...
But I don't know where to find them.

I'm not even sure if the stats are readily available. Stats NZ keeps some ACC-related data, but only addressing the composition of work-related injuries. I couldn't find anything related to denied claims nor their specifics.

[duckonin]

Link works now, I had an 's' in the wrong place...Yes I know what you want, I read the court cases to see how the magistrate views the problem offered..cheers

[Bald Eagle]

Disturbing item in the news article

""When you're talking about a couple of hundred being wrong out of 57,000 [a year], that's not a bad batting average."

Are they telling us they only had 57,000 claims or they turned down 57,000 and only got called out on a couple of hundred of them.

[duckonin]

B.E your bottom line would say it all..

[MSTRS]

Response sent...

Re. Letter Sat 22/5 Wear and tear is not an accident.
Of course it isn’t. No-one would dispute that.
Ms Cosgrove writes ‘This is especially problematic in complex areas like shoulders, backs and knees’. She also says ’ACC is not using wear and tear as an excuse.’
However, it is apparent that ACC does use this as an excuse to deny claims, almost as a matter of course, no doubt in the cynical hope that a significant proportion of genuine claimants will ‘just go away’. I understand 57,000 claims were denied last year.
Ones like the recent case of a 17 year old netballer, who suffered a knee injury on the court. She was declined cover because of wear and tear. A 17yo girl with worn-out knees? What? How did she play netball?
Or a friend of mine hurt his knee whilst working. The doctor said it was likely to be a bursitis, but scans and an MRI proved he had torn his AC ligament. But ACC refuse to cover him because they say the original diagnosis is right.
Or a woman who had her right arm amputated as a result of an accident. She was declined a lump sum payment ‘Because her arm might grow back’. What?
Have ACC become medical experts? Certainly declining claims appears to be official policy now.
Genuinely injured people now have to pay a specialist for a second opinion, or even take legal action.
Levies are up and cover is down. Whilst ACC continues to post record profits. And they are profits, not a ‘surplus’. Because they pay tax on these gains. The govt hides this by calling it a dividend.
Woodhouse’s ACC was a social contract, and we are being robbed.

[MSTRS]

Very interesting reply. No further denial of the wear and tear issue. But a full range of medical experts on staff, eh?
Anyone care to comment?

[MSTRS]

It occurs to me that for ACC to 'have medical experts on staff', there is no chance of avoiding the perception (at the very least) of independence in matters of a medical nature.
It's the Golden Rule in action (he who has the gold, makes the rules).

I would like to respond to this latest bit of bullshit, appropriately. But I could use a little help.

[yungatart]

So they have medical personnel on staff... wouldn't it be cheaper to just contract that out?

[MSTRS]

Response sent

So ACC consider themselves medical experts? Because they have such people on staff?
Well, I’m sorry, but with ‘experts’ who deny cover to 17 year olds because they reckon it’s wear and tear, who deny cover based on a wrong diagnosis, who deny compensation because limbs might grow back – who, indeed, are paid by the very people denying cover to the injured – I’d be wanting someone truly independent to make those medical calls.
ACC should be a place where the Golden Rule has no place.