Necessary Part or Ordinary Consequence of Treatment
Policy v10.0
b
Summary
It is important to ensure that medical studies and statis-
tics are both reliable and relevant to the circumstances of
the client and the treatment. Some studies may lack
Objective
validity because of their small sample size, for example,
Use this guidance to help you determine whether the treat-
or the study group may not be representative of the
ment injury suffered by a client was a necessary part or ordi-
client’s circumstances.
nary consequence of the treatment. This will help you determine
cover for a Treatment Injury claim.
c Factors to consider when referring to studies include:
1) Necessary part of the treatment
• The number of cases in the study and whether they are
2) Ordinary consequence of treatment
representative of the client’s circumstances. For example,
3) Likelihood of injury at a population level
a study of risks conducted at a single specialist facility
4) Client circumstances
overseas may be of limited relevance to a procedure in
5) Clinical knowledge at the time of treatment
New Zealand.
6) Changes in clinical knowledge
7) Clinical experience of the treatment provider
• How authoritative are the studies? Are they endorsed by
8) Questions to consider when determining whether an injury is
other experts? Is there a general consensus within that
an ordinary consequence of treatment
particular field or specialty?
9) Links to legislation
4.0 4.0 Client circumstances
Background
a The likelihood of an injury occurring must be viewed in
There is no cover for a treatment injury if the personal injury
light of the client's circumstances. Relevant factors are
suffered was a necessary part or ordinary consequence of the
discussed below.
treatment, taking into account all the circumstances of the treat-
b Duration and severity of the injury
ment. See the Accident Compensation Act 2001, Section 32.
An unusually severe outcome – either in its effect or in its
Owner
Alex Taylor
duration – may not be ordinary even though a less signif-
Expert
Chelsea Brouwers
icant injury that may commonly occur following that treat-
ment is more likely to be ordinary. In other cases, a
severe injury may still be an ordinary consequence of
Policy
treatment.
1.0 Necessary part of the treatment
NOTE Example - infections
a An injury that is a necessary part of the treatment is one
NOTE Example - heart surgery
that is an essential component of the treatment process,
c
e.g. an incision performed as part of an operation.
Underlying patient health considerations
Some people may be more susceptible to suffering ad-
verse outcomes from treatment than others, due to their
2.0 Ordinary consequence of treatment
health condition. This particular criterion requires the
a The Court of Appeal in ACC v Ng & others [2020] NZCA
decision maker to take into account the particular
274 interpreted ‘not an ordinary consequence’ as being
person’s circumstances at the time of treatment.
an outcome that is outside of the normal range of out-
comes, something out of the ordinary which occasions a
While a risk of injury may be unexpected for many people
measure of surprise.
undergoing the treatment, a particular person may pos-
sess certain clinical features, such as co-morbidities or a
b This is not a precise test and requires a judgement-based
predisposition, which increases their risk to such an
approach to each case, based on the specific circums-
extent that the injury becomes an ordinary consequence
tances of the treatment and the client, such as:
for them.
a) the likelihood of injury at a general population level
Conversely, a person may have a lower risk of injury aris-
ing from a particular treatment, compared to other
b) the particular circumstances of the client's case
people. As a result, the injury may not be an ordinary
consequence for that particular person.
c) the clinical knowledge at the time of treatment.
d Circumstances of the treatment
NOTE Example
Ordinary consequences will also depend on the particular
treatment or procedure. Each examination, treatment, or
3.0 The likelihood of injury at a population level
procedure will have its own profile of ordinary conse-
a Data on the risk of a treatment can help identify a base-
quences.
line probability of injury . This information may come from
medical studies, the experience of experts, or other reli-
The facilities available, the urgency and complexity of the
able sources..
treatment, as well as the experience of the attending
health professional(s) may also be relevant when deter-
mining whether an outcome was an ordinary conse-
quence.
NOTE Example - emergency surgery
ACC > Claims Management > Manage Claim Registration and Cover Decision > Operational Policies > Cover Decision > Treatment Injury Criteria > Necessary Part or Ordinary
Consequence of Treatment Policy
Uncontrolled Copy Only : Version 10.0 : Last Edited Tuesday, 26 October 2021 3:34 PM : Printed Tuesday, 23 November 2021 10:13 AM
Page 1 of 3
5.0 Clinical knowledge at the time of treatment
8.0 Questions to consider when considering a
a Whether an outcome is considered ‘ordinary’ needs to be
treatment injury claim
considered in light of the clinical knowledge that existed
a What was the treatment the client received that has given
at the time of the treatment, as recognised by the rele-
rise to the injury?
vant profession. This includes accepted practice in New
Zealand and international knowledge.
What is the nature of the injury that is being claimed for?
b The focus of the assessment is also not based on wheth-
er the risk of the outcome was predicted (or could have
Are there any medical studies that provide reliable and
been predicted) in advance of treatment in a particular
relevant statistical analysis about the particular injury?
client’s case. The assessment can take into account facts
discovered after treatment has commenced, including
Are these studies relevant to the client’s circumstances?
complications that were not known when the procedure
started.
Is the injury unusually severe or long-lasting compared to
the medical studies and analyses that are available?
NOTE Example
Were there any circumstances that increased or reduced
the risk of the injury occurring? That might include:
6.0 Changes in clinical knowledge
a
• Patient factors (which may include depending on the
The prevailing medical and scientific knowledge at the
context such factors as age, smoking status, BMI, other
time that treatment is taking place is to be taken into ac-
health conditions);
count. Advances in clinical knowledge that are acquired
• Circumstances of treatment (urgency, available facil-
after treatment has finished should not be taken into ac-
ities);
count when making a decision on whether an injury is an
ordinary consequence.
• What happened during treatment – what was found
b The following table summarises how this is applied.
during surgery (eg deteriorated arteries that were not vis-
ible pre-surgery).
Clinical knowledge summary table.jpg
c Cover may not be available where clinical knowledge at
Have client factors increased or decreased the identified
the time of treatment has been superseded, making an
risks of the treatment? If so, by how much?
injury not a necessary part or ordinary consequence of
treatment.
Was the risk identified before treatment and what was the
scope of consent prior to treatment? This may provide
Cover may be available where there was no clinical
evidence to help clarify how significant the risk was be-
knowledge at the time of treatment that an injury could
lieved to be before treatment began, but treatment pro-
occur, even though clinical knowledge today would make
viders will obtain consent for many unlikely possibilities
the injury a necessary part or ordinarily consequence of
and things may change in the course of treatment. The
treatment.
question is the objective likelihood of the outcome, not
whether it was identified.
NOTE Example - radiation treatment in the 1980s to
Considering all the above factors, was the nature and the
treat a tumour, causing damage to surrounding
severity of the injury within the normal range of outcomes
bone and tissue
for the treatment provided to this patient?
Radiation treatment example.jpg
NOTE Example - lithium drugs prescribed to treat
depression, resulting in renal failure
9.0 Links to legislation
Lithium drugs example.jpg
Accident Compensation Act 2001, Section 32, Treat-
ment injury
http://www.legislation.govt.nz/act/public/2001/0049/latest/DLM100934.html
7.0 Clinical experience of the treatment provider
a The clinical experience of the treatment provider may
sometimes be relevant. For example, where a procedure
Triggers & Inputs
might carry a significant risk when competently con-
ducted by a general surgeon, even though an expert
TRIGGERS
specialising in the procedure could have performed the
None Noted
same procedure with a lower risk of the injury occurring.
It is the risk associated with procedures performed by
that generalist that is relevant, not the risk associated
INPUTS
with procedures performed by the specialist.
None Noted
Outputs & Targets
OUTPUTS
None Noted
PERFORMANCE TARGETS
None Noted
ACC > Claims Management > Manage Claim Registration and Cover Decision > Operational Policies > Cover Decision > Treatment Injury Criteria > Necessary Part or Ordinary
Consequence of Treatment Policy
Uncontrolled Copy Only : Version 10.0 : Last Edited Tuesday, 26 October 2021 3:34 PM : Printed Tuesday, 23 November 2021 10:13 AM
Page 2 of 3
Process Dependencies
PROCESS LINKS FROM THIS PROCESS
None Noted
PROCESS LINKS TO THIS PROCESS
None Noted
RACI
RESPONSIBLE
Roles that perform process activities
None Noted
Systems that perform process activities
None Noted
ACCOUNTABLE
For ensuring that process is effective and improving
Process
Alex Taylor
Owner
Process
Chelsea Brouwers
Expert
CONSULTED
Those whose opinions are sought
STAKEHOLDERS
None Noted
STAKEHOLDERS FROM LINKED PROCESSES
None Noted
INFORMED
Those notified of changes
All of the above. These parties are informed via dashboard
notifications.
Systems
None Noted
Lean
None Noted
Process Approval
Date
Approver
Type
26-10-2021 (GMT)
Stuart
Process Expert
Knight
26-10-2021 (GMT)
Alex Taylor
Process Owner
26-10-2021 (GMT)
Kirsty
Promaster
Jones
Published on 26-10-2021 (GMT) by Kirsty Jones
ACC > Claims Management > Manage Claim Registration and Cover Decision > Operational Policies > Cover Decision > Treatment Injury Criteria > Necessary Part or Ordinary
Consequence of Treatment Policy
Uncontrolled Copy Only : Version 10.0 : Last Edited Tuesday, 26 October 2021 3:34 PM : Printed Tuesday, 23 November 2021 10:13 AM
Page 3 of 3
