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Request for official information about ACC claims panels

David Lawson made this Official Information request to Accident Compensation Corporation

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From: David Lawson

Dear Accident Compensation Corporation,

On 28 June 2017 an Official Information Request was lodged with the Accident Compensation Corporation through the www.fyi.org.nz website:-

https://fyi.org.nz/request/6076-concussi...

The Corporations response to requesters Official Information request has significant relevance to way that the Corporation is currently claims managing/not claims managing the injuries that I have suffered from several accidents involving concussion, and therefore I am also interested in the Corporations response to the submitters Official Information requests being made publicly available to me and the wider general public as a matter of public interest and transparency.

I note that the Corporations OIA response through www.fyi.org.nz, drew the requesters attention to the fact that an ACC Case Manager provided them with a response to his Official Information Act questions by email on 7 July 2017.

I also note that requester has subsequently recorded that his request for this Official Information has been successful in response to the Corporations letter dated 14 July 2017.

I therefore respectfully request that the Corporation provide me with the following Official Information;

1/ Please name Concussion specialists used on Complex Medical Panels and why ACC consider these people qualified and specialized up to date in Concussion particularly in the long term effects of undiagnosed complications/consequences

2/ Will ACC provide an opportunity to have any Claimants specialists present at review in order to scrutinize and debate their history and potential outcomes with ACC appointed people

3/ Will ACC fund any such Claimants specialists present at review that has been involved in Claimants care

4/ What questions are usually asked at a Complex medical review where Concussions and Historical arrears claims are concerned

5/ Is there anything a Claimant can do in a Layman capacity to assist ACC to carry out review in a timely and orderly manner in order to get the full story on the table

6/ What format is typically proven more helpful, historically, to put forward evidence in order to be more successful in obtaining and proving a significant arrears entitlement

7/ In 1996/1997 was there a requirement whether by legislation, privacy act, or 'good courteous conduct', to invite the client to any meeting held by an ACC CM and their employer. Particularly where it was an issue of ongoing employment and ability/inability to work due to injury.

In addition to the above 7 OIA question's, I also request that the Corporation provide me with the following additional information.

8. When the Corporation refers a claimant for any assessment to an externally contracted provider, by law, natural justice and ACC process the Corporation is obliged to provide the claimant with a notice of such requirement and to provide full copies of all information to the client for which the Corporation proposes to send to the assessor. This should be done prior to the assessment, allowing the claimant sufficient time and the ability to address any required issues re cover and entitlements, and seek any corrections, omissions, misleading information be corrected prior to the assessment.

When assessing claim and entitlement assessment, the relevant ACC claims unit commonly seek information directly from the claimant, and from personal experience in several claims to date, ACC have then proceeded to approach an ACC panel to make a decision on claims acceptance and or declinature.

In my cases, ACC's use of a panel has never been advised to me prior to the ACC claim staff placing information before a panel for the purposes of the panel making a decision.

As a consequence, as the party whom has lodged the claim for cover and entitlements, and who has suffered the accident concerned, ACC prior to approaching an internally appointed ACC Panel for a decision on cover, never;-

(a) Informed me that the ACC staff member was going to approach an internal ACC panel to make a decision on cover acceptance and entitlements.

(b) Informed me that ACC will not be seeking external advice on matters pertaining to the injury/ies that I seek cover and entitlements for,

(c) Informed me of the most appropriate medical specialty from which external advice on matters pertaining to the injury/ies that I seek cover and entitlements for should be sought from, nor had I received ACC's request for the Corporation to be able to seek such specialist medical opinion from a practicing medical specialist within the medical specialty which assess, diagnose, treat and rehabilitate the injuries associated with the specific accidental injuries that I have.

(d) Supplied me with copies of the information that ACC put forward to the panel on ACC's behalf, nor had ACC provided me with the copies of the information that the Corporation had supplied to the panel, in which I had provided to the Corporation.

(e) I was therefore not in a position to be able to redress with the Corporation, directly prior to an ACC Panel becoming involved, the accuracy of the information put to the Panel by the claims staff member in terms of;

(i) it's accuracy,
(ii) whether substantive information had been omitted,
(iii) whether information supplied to the panel by the ACC claims staff member was relevant, and not misleading, nor outdated.

(f) and I was never given an opportunity to be heard in front of this panel, or have a representative present to be heard as part of ACC's claim's panel process.

(g) the Corporation never provided me with a transcript or audio recording of the claim's panel discussion which lead to them making a decision about my claim.

(h) the Corporation never provided me with written confirmation that the ACC panel members who made the decision of claim acceptance, were vocationally qualified in the area of the medical specialty in which my accidental injuries are assessed, diagnosed, treated and rehabilitated within.

This is especially concerning when for instance under claim number 10031989043, injury to my facial nerves, which are vocationally medically assessed, diagnosed, treated and rehabilitated within the field of neurosurgery, was referred internally by a treatment injury staff member to an ACC internal medical assessor who was a retired orthopaedic surgeon, not trained in neurosurgery, and then forwarded to an ACC panel which membership did not consist of a neurosurgeon. Not one person in the whole process was vocationally trained/qualified to make a decision either way on the acceptance or declinature of cover for the claim and entitlements.

OIA Request Question 8:

I therefore also respectfully request to be supplied with copies of all of the Corporation's legal advice that the Corporation relies upon to be able to offer as part of their service package to a claimant, services through internally appointed, medical assessors and ACC Claims Panels which limit a claimant's legal rights to be fully informed by the most suitable vocationally qualified medical specialist, heard, and their ability to be able to participate/ or be represented in the Claims panel claims and entitlement decision making process, and for which the claimant is left with no ability as evidenced above to be able to ensure that the advice sought by the Corporation has been provided by a medical specialist vocationally trained within the field that the class of injury is assessed, diagnosed treated and rehabilitated. Please ensure that the information that I seek addresses individually and separately each of the areas that I have addressed under question 8 (a), 8 (b), 8 (c), 8 (d), 8 (e) (i), (ii) & (iii), 8 (f), 8 (g) & 8 (h).

I respectfully request that the above information is provided under urgency within the 20 working days permissible under the Official Information Act, with the information being requested with this period for the purposes of claim management and the assessment of concussion related injuries.

I confirm that under s16(2) of the Official Information Act, my preferred way of receiving a response is by email to the address from which ACC received the original request, not by post.

I appreciate your time and assistance.

Yours faithfully,

David Lawson

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From: Government Services
Accident Compensation Corporation

Good afternoon Mr Lawson

I acknowledge your request of 18 September 2017.

Please note, we will respond to your request as soon as reasonably possible, and certainly by 13 October 2017.

Regards

Government Engagement and Support
ACC

Disclaimer:

"This message and any attachments may contain confidential and privileged information.
If you believe you have received this email in error, please advise us immediately by
return email or telephone and then delete this email together with all attachments.
If you are not the intended recipient, you are not authorised to use or copy this message
or any attachments or disclose the contents to any other person."

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From: David Lawson

Dear Government Services,

Thank you for your email received today and reads;

"Good afternoon Mr Lawson

We refer to the following request posted on the FYI website:
https://fyi.org.nz/request/6557-request-...

Request for official information about ACC claims panels ...
fyi.org.nz
Printed from https://fyi.org.nz/request/6557-request-... on September 17, 2017 12:12

Your request refers to the ‘Complex Medical Panel’, however, there is no panel that goes by this title.

We understand that you are referring to the Complex Claims Panel, as this is relevant to your claim 10031989043. Could you please confirm whether our understanding is correct?

Timeframe for response
Once you have provided the clarification we require, we will work on providing you with a response. In accordance with section 15(1AA) of the Official Information Act 1982, the timeframe for responding to your request will reset to 20 working days from the day after you provide clarification.

Could you please provide clarification by return email by 3 October 2017.

Regards
Government Engagement and Support"

My response follows;

OIA Requests 1 to 7 replicate exactly what the original requester asked through FYI at https://fyi.org.nz/request/6076-concussi....

The original requester has acknowledged that the information was successfully provided by ACC to them and my original request to be provided with the same information that was provided.

Since the original reference was to Complex Medical Panels, and since I am unsure as to whether there is more than one panel that concussion decisions may be internally ruled/reviewed on within ACC, I would appreciate you listing additionally, for the purposes of answering OIA requests 1 through 7 any and all internal ACC panels that decisions on concussion are reviewed and ruled upon, within ACC.

In respect of OIA Request 8

I would expect that ACC's response to OIA Request 8 would also pertain to, but not be limited solely to the Complex Claims Panel, but will also respond in the wider context to also include other ACC services (e.g.Sensitive Claims, the team that handles spinal claims and injuries....etc) associated with any and all internally appointed, medical assessors and ACC Claims Panels in which decisions are made by ACC on assessment, treatment, cover and rehabilitation.

I respectfully request that the above information is provided under urgency within the 20 working days permissible under the Official Information Act, with the information being requested with this period for the purposes of claim management and the assessment of concussion related injuries.

I confirm that under s16(2) of the Official Information Act, my preferred way of receiving a response is by email to the address from which ACC received the original request, not by post.

I appreciate your time and assistance.

Yours sincerely,

David Lawson

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From: Government Services
Accident Compensation Corporation

Good morning Mr Lawson

Thank you for your email of 26 September 2017, clarifying your request of 16 September 2017.

ACC is working on your request and will be in touch with you as soon as possible.

Please note, the final date for a decision on your request is 25 October 2017. This is 20 working days after the day you clarified your request. This timeframe complies sections 15(1AA) and 15(1AB) of the Official Information Act 1982.

Regards
Government Engagement and Support
ACC 

 
 
 
 

Disclaimer:

"This message and any attachments may contain confidential and privileged information.
If you believe you have received this email in error, please advise us immediately by
return email or telephone and then delete this email together with all attachments.
If you are not the intended recipient, you are not authorised to use or copy this message
or any attachments or disclose the contents to any other person."

Link to this

From: Government Services
Accident Compensation Corporation


Attachment Response D Lawson.pdf
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Good afternoon Mr Lawson

 

Please find ACC’s response to your request 18 September 2017, which you
amended on 26 September 2017.

 

Regards

Government Engagement and Support

ACC

Disclaimer:

"This message and any attachments may contain confidential and privileged
information. If you believe you have received this email in error, please
advise us immediately by return email or telephone and then delete this
email together with all attachments. If you are not the intended
recipient, you are not authorised to use or copy this message or any
attachments or disclose the contents to any other person."

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