ACC is doing my head in!

[Bikernereid]

If you are having trouble with ACC I would fight it. It took me nearly four months to get them to respond to my surgeon's request. Firstly they sent a request for more information to Auckland hospital and yet I reside in Chch. Secondly they sent the request for more information to the wrong hospital in Chch hence the delay. I think they may be using delaying tactics with claims (as suggested by others on here) due to funding problems. keep your chin up!!

[Robert Taylor]

Well I am at the start of this journey, I am also fairly tenatious and am really unlikely to back off. I hope the fact that I made an early "official" complaint will hurry up some decision making.



Cool! Thanks for that mate. Wish you could see the thumbs up and crazy grin that accompaines my thanks

We dont fucken have private insurance as we ARE ALREADY COVERED by ACC. I am appaled that someone like you who is a big defender of the little guy in business can actually be so blase about a little gal (potentially) being done over by ACC!

By all means if we are to lose ACC let me have the fucking right to SUE the doctors and the drug companies and any other bastard me and my attorneys that get paid a % of the return can think of. For now I AM covered by ACC, I pay shitloads of fucken premiums to them and I DEMAND cover that I am entitled to, I also expect common decency in as much as a written acknowledgement of my claim regardless of what it is called, I dont expect to have to ring them 2 weeks after the claim was lodged to discover that Helen will "get to it in the next few days".

I do seriously sympathise with your plight but Im saying that the ACC system is a rort and needs some serious dismantling, in part to relieve the burden on taxpayers. If that can go hand in hand with seriuos tax reductions then I say bring on the private system. I personally think the medical system should be a whole load more accountable, not to silly levels of litigation as in the US but not being able to hide behind ACC as they do now. Its clearly not working well for you!

[Toaster]

That's utterly fucking disgusting.

So is a poo sandwich.

ACC were appalling to Mom, me and many many others left to swing in the breeze.

[SixPackBack]

Gotta say I love ACC. The treatment received for my injury was superlative:

• 2 months of salary payments
• Hospital stay in Ascot complete with my own shower tea/coffee etc.
• On going rehab.....

My treatment was the reason I neglected to comment on the recent rego hike, and gotta say medical misadventure is hardly an accident!

[Mom]

So is a poo sandwich.

ACC were appalling to Mom, me and many many others left to swing in the breeze.

I will happily post up here when they accept my claim and reimburse me for my ambo trips etc. Interestingly enough these two operate like a tag team Cam. I reckon they PM each other, ones stirs, one reps, pathetic really. At very least, I want the cost of the doctor appointments reimbursed. $140 for a Sunday at Red Beach. Then the Saturday and Monday at Warkworth. 80% of 5/8ths wages is not such a big deal

[mashman]

So essentially people are being abandoned by their government, because you can "fall through the cracks"... pretty horrendous thought considering you pay for that cover throughout your life and you are an economically viable asset to the government... why wouldn't they want to help you? looks like bad economic policy to me.

[Usarka]

Does this fall under the definition of an accident (for the purposes of ACC)?
Whilst I realise that no one knowingly has an adverse reaction to a drug etc, neither does anyone knowingly say contract a disease.
Even the haemophiliacs who contracted Hep C from tainted blood didn't get ACC cover.
Would not a medical condition (such as an adverse reaction) fall outside the scope of an accident?
Should hayfever therefore be covered by ACC?

ACC do have a treatment injury budget. If something goes wrong during treatment for an ACC claim then you should be covered.

Caveats etc http://www.acc.co.nz/for-providers/l...laims/PRV00032

[rainman]

I do seriously sympathise with your plight but Im saying that the ACC system is a rort and needs some serious dismantling, in part to relieve the burden on taxpayers. If that can go hand in hand with seriuos tax reductions then I say bring on the private system. I personally think the medical system should be a whole load more accountable, not to silly levels of litigation as in the US but not being able to hide behind ACC as they do now. Its clearly not working well for you!

Robert, you seem to be trotting out the old "government bad, privatise good, lower taxes..." lines, but how do you see this actually working? Example: I have a buggered back, from a sporting injury. ACC have covered me (sorta) and continue to look after it (increasingly poorly, as National tries to break ACC and public faith therein by cutting everything they can). Let's say your dream comes true, and we privatise ACC. What happens to poor buggers like me? No hope of getting reasonably priced cover for a pre-existing condition, if I can get private cover at all. But I've already paid my premiums through tax. If you privatise I assume you woud not propose handing the private insurers a bunch of taxpayer money? Good luck with that!

If you force the private insurers to cover pre-existing conditions you actually have to regulate that over the lifetime of the population that get grandfathered over, or those dodgy buggers will cut cover as soon as they can. Don't believe that? Have a close look at the US medical insurance systems. So if you do successfully force pre-existing cover, you've gained nothing financially.

If you don't, people like me go either untreated (and end up unable to work, so labour productivity drops further), or on the public health system - remember no private co is insane enough to cover us - so public cost for private gain. And you have to find room for a profit in there somewhere...

And if your claim is that governments are sooooo terrily inefficient that there will be heaps of money saved from privatising, I'll challenge you to prove that with hard data and facts. Good luck with that too.

Sorry, but your way sounds stupid to me. Which is the general problem with neoliberal bullshit generally. It sounds lovely in theory, but doesn't work in practice. Unless you're the private insurer, getting rich(er) at the rest of our expense, of course.

[p.dath]

Scary as it is, I woke up thinking about your case Mom. I woke up thinking about "what is an accident". Could you perhaps go and look at the ACC legislation and post the definition of accident here for us? Legislation can be found here:
http://www.legislation.govt.nz/

The reason I was thinking about this is because I was reflecting on stays I have had in hospital. Two of them have been paid for by my private medical insurance.

And then this led me to wonder if he have a mis-understanding about what ACC is covering us for. My initial reaction was that ACC should be covering you because it was a medical accident (excuse my simple terms). It wasn't a planned event, but perhaps I am also mis-understanding the cover that ACC is providing - and perhaps this is the point where private medical cover takes over.

[Mom]

Scary as it is, I woke up thinking about your case Mom.

You poor bugger


http://www.legislation.govt.nz/act/p...dent_resel&p=1

25 Accident
(1) Accident means any of the following kinds of occurrences:

(a) a specific event or a series of events, other than a gradual process, that—

(i) involves the application of a force (including gravity), or resistance, external to the human body; or

(ii) involves the sudden movement of the body to avoid a force (including gravity), or resistance, external to the body; or

(iii) involves a twisting movement of the body:

(b) the inhalation of any solid, liquid, gas, or foreign object on a specific occasion, which kind of occurrence does not include the inhalation of a virus, bacterium, protozoan, or fungus, unless that inhalation is the result of the criminal act of a person other than the injured person:

(ba) the oral ingestion of any solid, liquid, gas, fungus, or foreign object on a specific occasion, which kind of occurrence does not include the ingestion of a virus, bacterium, or protozoan, unless that ingestion is the result of the criminal act of a person other than the injured person:

(c) a burn, or exposure to radiation or rays of any kind, on a specific occasion, which kind of occurrence does not include a burn or exposure caused by exposure to the elements:

(d) the absorption of any chemical through the skin within a defined period of time not exceeding 1 month:

(e) any exposure to the elements, or to extremes of temperature or environment, within a defined period of time not exceeding 1 month, that,—

(i) for a continuous period exceeding 1 month, results in any restriction or lack of ability that prevents the person from performing an activity in the manner or within the range considered normal for the person; or

(ii) causes death.

(2) However, accident does not include—

(a) any of those kinds of occurrences if the occurrence is treatment given,—

(i) in New Zealand, by or at the direction of a registered health professional; or

(ii) outside New Zealand, by or at the direction of a person who has qualifications that are the same as or equivalent to those of a registered health professional; or

(b) any ecto-parasitic infestation (such as scabies), unless it is work-related; or

(c) the contraction of any disease carried by an arthropod as an active vector (such as malaria that results from a mosquito bite), unless it is work-related.

(3) The fact that a person has suffered a personal injury is not of itself to be construed as an indication or presumption that it was caused by an accident.

Compare: 1998 No 114 s 28

Section 25(1)(a): substituted, on 1 July 2005, by section 10(1) of the Injury Prevention, Rehabilitation, and Compensation Amendment Act (No 2) 2005 (2005 No 45).

Section 25(1)(b): substituted, on 1 July 2005, by section 10(2) of the Injury Prevention, Rehabilitation, and Compensation Amendment Act (No 2) 2005 (2005 No 45).

Section 25(1)(ba): inserted, on 1 July 2005, by section 10(2) of the Injury Prevention, Rehabilitation, and Compensation Amendment Act (No 2) 2005 (2005 No 45

[Mom]

Now this is interesting;

(2) However, accident does not include—

(a) any of those kinds of occurrences if the occurrence is treatment given,—

(i) in New Zealand, by or at the direction of a registered health professional; or

Hmmmmm...


13 New sections 32 to 34 substituted
The principal Act is amended by repealing sections 32 to 34, and substituting the following sections:

“32 Treatment injury
“(1) Treatment injury means personal injury that is—

“(a) suffered by a person—

“(i) seeking treatment from 1 or more registered health professionals; or

“(ii) receiving treatment from, or at the direction of, 1 or more registered health professionals; or

“(iii) referred to in subsection (7); and

“(b) caused by treatment; and

“(c) not a necessary part, or ordinary consequence, of the treatment, taking into account all the circumstances of the treatment, including—

“(i) the person's underlying health condition at the time of the treatment; and

“(ii) the clinical knowledge at the time of the treatment.

“(2) Treatment injury does not include the following kinds of personal injury:

“(a) personal injury that is wholly or substantially caused by a person's underlying health condition:

“(b) personal injury that is solely attributable to a resource allocation decision:

“(c) personal injury that is a result of a person unreasonably withholding or delaying their consent to undergo treatment.

“(3) The fact that the treatment did not achieve a desired result does not, of itself, constitute treatment injury.

“(4) Treatment injury includes personal injury suffered by a person as a result of treatment given as part of a clinical trial, in the circumstances described in subsection (5) or subsection (6).

“(5) One of the circumstances referred to in subsection (4) is where the claimant did not agree, in writing, to participate in the trial.

“(6) The other circumstance referred to in subsection (4) is where—

“(a) an ethics committee—

“(i) approved the trial; and

“(ii) was satisfied that the trial was not to be conducted principally for the benefit of the manufacturer or distributor of the medicine or item being trialled; and

“(b) the ethics committee was approved by the Health Research Council of New Zealand or the Director-General of Health at the time it gave its approval.

“(7) If a person (person A) suffers an infection that is a treatment injury, cover for that personal injury extends to—

“(a) person A's spouse or partner, if person A has passed the infection on directly to the spouse or partner:

“(b) person A's child, if person A has passed the infection on directly to the child:

“(c) any other third party, if person A has passed the infection on directly to that third party:

“(d) person A's child or any other third party, if—

“(i) person A has passed the infection directly to his or her spouse or partner; and

“(ii) person A's spouse or partner has then passed the infection directly to the child or third party.

“33 Treatment
“(1) For the purposes of determining whether a treatment injury has occurred, or when that injury occurred, treatment includes—

“(a) the giving of treatment:

“(b) a diagnosis of a person's medical condition:

“(c) a decision on the treatment to be provided (including a decision not to provide treatment):

“(d) a failure to provide treatment, or to provide treatment in a timely manner:

“(e) obtaining, or failing to obtain, a person's consent to undergo treatment, including any information provided to the person (or other person legally entitled to consent on their behalf if the person does not have legal capacity) to enable the person to make an informed decision on whether to accept treatment:

“(f) the provision of prophylaxis:

“(g) the failure of any equipment, device, or tool used as part of the treatment process, including the failure of any implant or prosthesis (except where the failure of the implant or prosthesis is caused by an intervening act or by fair wear and tear), whether at the time of giving treatment or subsequently:

“(h) the application of any support systems, including policies, processes, practices, and administrative systems, that—

“(i) are used by the organisation or person providing the treatment; and

“(ii) directly support the treatment.

“(2) Subsection (1) does not affect the application of the definition of treatment in section 6(1) for purposes other than those stated in subsection (1).

“(3) Subsection (2) is for the avoidance of doubt.

“34 Cover for personal injury caused by medical misadventure before 1 July 2005
“(1) This section applies to—

“(a) claims for cover for personal injury caused by medical misadventure that were lodged with the Corporation before 1 July 2005, but have not been determined; and

“(b) claims for cover for personal injury caused by medical misadventure that were declined by the Corporation before 1 July 2005, but are lodged again on or after that date as claims for cover for treatment injury (and not lodged as claims referred to in subsection (4)).

“(2) Claims lodged in the circumstances described in subsection (1) must be determined under the relevant provisions in force immediately before 1 July 2005.

“(3) Reviews and appeals must be dealt with under the relevant provisions of Part 5 in force immediately before 1 July 2005, if the decision being reviewed or appealed—

“(a) was made before 1 July 2005; or

“(b) is one to which subsection (2) applies.

“(4) Subsection (1)(b) does not apply in relation to a claimant if,—

“(a) before 1 July 2005, the Corporation declined the claimant's claim for cover for personal injury caused by medical misadventure because there was no personal injury; and

“(b) on or after 1 July 2005, the claimant lodges a claim for cover for treatment injury in respect of a personal injury that—

“(i) occurred after the decision to decline the earlier claim (whether before or after 1 July 2005); and

“(ii) arises out of the circumstances on which the earlier claim was based.”

[p.dath]

Depending on the definition of "injury", it sounds like you should be covered. Not because you had a medical accident, but because you suffered a "treatment injury".

Oh well, at least you know the terms to use now when discussing your complaint with them.

[Genie]

Had some issues when my son was going though some stuff....keep a detailled account of all your convos with them, names are very important...try to speak to the same person all the time and just keep annoying them. they are a bunch of twats, their hands are tied with red tape and they always seem to have the need to "speak with my supervisor about that as I'm not sure".....good luck

[Mom]

I talked to a chick yesterday that broke her Archillies Tendon. She was playing chasey with her kids in the back yard and it just went bang.

ACC did not accept liability for her claim! Was not an accident apparently, she was not playing sport when it happened, it must have been a congenital weakness if you please. Any reason, any excuse. SHe battled them for months and eventually actually gave up as it was affecting her mental health to be battling them on an almost daily basis.

[mashman]

I talked to a chick yesterday that broke her Archillies Tendon. She was playing chasey with her kids in the back yard and it just went bang.

ACC did not accept liability for her claim! Was not an accident apparently, she was not playing sport when it happened, it must have been a congenital weakness if you please. Any reason, any excuse. SHe battled them for months and eventually actually gave up as it was affecting her mental health to be battling them on an almost daily basis.

A colleague of mine tripped over a football (he was warming up, they weren't even playing)... ripped his tendon, broke 2 bones in his leg, ligaments etc... the Doc couldn't believe the cause of the injuries because it was so innocuous... My colleague is stunned himself... he didn't think anything of what he was doing and BANG broken leg... At the moment he IS BEING DEALT WITH BY ACC... ACC where also here in the office last week and he only did his leg 10 days ago... Something wrong somewhere me thinks...