Printed from https://fyi.org.nz/request/23716-claim-assessments-specific-questions-regarding-scans-and-diagnoses on December 22, 2024 03:50

Claim assessments - specific questions regarding scans and diagnoses

Monica made this Official Information request to Accident Compensation Corporation

The request was successful.

From: Monica

Dear Accident Compensation Corporation,

I have some very specific questions regarding assessment of claims, which I can not find the answer for in published policies. If I have missed something, I would be grateful for the reference of where to look, or alternatively, a formal response is appreciated.

1) When a claim is being assessed, and medical records are being reviewed from multiple providers, and there are different 'guesses' at the diagnosis (ie, one provider says a strain, one says a ruptured ligament, one says nerve damage), how does the assessor determine which is correct? Or is the idea to decline based on no definitive answer?

2) When medical records are being reviewed, and a client has a scan for an unrelated issue (ie not looking for a cause of current injury), who reviews these scans and says they are 'normal'? Is that the assessor or a medical specialist? For example, if someone had a claim for a suspected coccyx injury and had had an abdominal CT performed for a pre existing condition which was marked as normal (the coccyx wasn't even assessed), then for an ACC assessor to say that that scan was not showing any sign of injury, they would had to have viewed the scans and made a report? Please let me know what the policy is in this situation.

3) Do cover assessors have a medical background? The reason I ask is that one with medical knowledge should know that some types of injuries take days or weeks to heal, and certain types of red flags on medical reports warrant a trip to the ER.

4) When you request medical records from specialists, do you expect to receive all information held about the patient and their assessments/injury or just the clinical letter sent to the GP? By all information, i'm referring to things like questionnaires completed during the assessment by the specialist, any notes that the patient gave to the specialist regarding symptoms/onset of injury etc.

Yours faithfully,

Monica

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From: Government Services
Accident Compensation Corporation

Kia ora

 

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From: Government Services
Accident Compensation Corporation

Attachment GOV 026905 Appendix.pdf
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Attachment GOV 026905 Response.pdf
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Kia ora Monica

Please find attached our response to your official information request
dated 6 August 2023. If you have any questions about the response you can
contact us at this [1]address, for all other matters please use our
contact form at: [2]https://www.acc.co.nz/contact/ alternatively give us a
call on 0800 101 996.

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Ngâ mihi

Sara Freitag (she/her)
Acting Manager | OIA Services

' 027 973 7330
* PO Box 242, Wellington 6011

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