What are the process(s) around an ACC in-house advisor overruling a medical specialist?

S Ashworth made this Official Information request to Accident Compensation Corporation

The request was successful.

From: S Ashworth

Dear Accident Compensation Corporation,

On what grounds can an in-house ACC medical advisor ignore or overrule medical evidence provided by a medical specialist? If this happens, what are the checks and balances around this process?

I can confirm that I am a New Zealand citizen, resident in New Zealand and as such I am eligible to make Official Information Act requests.

Yours faithfully,

Ms Ashworth

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From: Government Services
Accident Compensation Corporation

Link: [1]File-List

Good afternoon Ms Ashcroft

 

I refer to your 4 requests dated 25 October 2017 asking for the following
information:

·         When ACC makes a decision to decline cover does it reference in
the letter communicating the decision which section(s) of the ACC Act 2001
the decision to deny cover was based on? If not, why not?

·         On what grounds can an in-house ACC medical advisor ignore or
overrule medical evidence provided by a medical specialist? If this
happens, what are the checks and balances around this process?

·         For the last 10 years, can ACC provide the number of accepted
Treatment Injuries as a result of the use of surgical instruments,
including sub-totals for the use of drills and saws?

·         For the last 10 years, can ACC provide the number of accepted /
declined ACC claims for CRPS (Chronic Regional Pain Syndrome) following
surgery.

For those declined, what were the reasons provided and against which
section(s) of the ACC Act was the decision made against? ACC may provide
summary information to ensure client confidentiality where the reason(s)
may potentially identify individuals.

 

This email is to acknowledge your requests and advise you that we will be
combining your requests and treating them as a single request.

We are currently working on your requests and will be in touch with you as
soon as possible, and certainly by 22 November 2017.

 

If you have any questions you can contact us via
[2][email address]

 

Yours sincerely

Government Engagement & Support team

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."

References

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2. mailto:[email address]

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From: Government Services
Accident Compensation Corporation

Dear Ms Ashworth

 

Official Information Act 1982 – Notification of Time Extension

On 25 October 2017 you asked for the following information under the
Official Information Act 1982 (the Act):

·         When ACC makes a decision to decline cover does it reference in
the letter communicating the decision which section(s) of the ACC Act 2001
the decision to deny cover was based on? If not, why not?

·         On what grounds can an in-house ACC medical advisor ignore or
overrule medical evidence provided by a medical specialist? If this
happens, what are the checks and balances around this process?

·         For the last 10 years, can ACC provide the number of accepted
Treatment Injuries as a result of the use of surgical instruments,
including sub-totals for the use of drills and saws?

·         For the last 10 years, can ACC provide the number of accepted /
declined ACC claims for CRPS (Chronic Regional Pain Syndrome) following
surgery.

For those declined, what were the reasons provided and against which
section(s) of the ACC Act was the decision made against? ACC may provide
summary information to ensure client confidentiality where the reason(s)
may potentially identify individuals.

 

ACC needs an extra 10 working days until 6 December 2017 to make a
decision on your request, as the request necessitates a search through a
large quantity of information. This extension complies with Section 15A of
the Act. ACC will do all it can to respond to your request before the new
due date, if that is at all possible.

 

Please contact us on [1][email address] if you would like to
discuss this letter. You may make a complaint to the Office of the
Ombudsman. You can call them on 0800 802 602, 9am to 5pm weekdays, or
write to: The Office of the Ombudsman, PO Box 10 152, WELLINGTON 6143.

 

Yours sincerely

Government Engagement and Support

 

 

 

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."

References

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1. mailto:[email address]

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From: Government Services
Accident Compensation Corporation


Attachment 0050875 Response.pdf
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Dear Ms Ashworth

 

Please find attached our response to your requests for information under
the Official Information Act 1982, dated 25 October 2017.

 

Yours sincerely

 

Government Engagement and Support

 

 

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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