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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

ACC cares about the environment – please don’t print this email unless it
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------------------- Original Message -------------------
From: Monica <[FOI #23716 email]>;
Received: Sun Aug 06 2023 00:38:01 GMT+1200 (New Zealand Standard Time)
To: ACC <[ACC request email]>; Government Services
<[ACC request email]>; <[ACC request email]>;
Subject: Official Information request - Claim assessments - specific
questions regarding scans and diagnoses

[You don't often get email from
[FOI #23716 email]. Learn why this is
important at [4]https://aka.ms/LearnAboutSenderIdentific... ]

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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