ACC review concerns ‘not rocket science’

CONCERNS about the independence of the ACC review process ‘‘are not rocket science’’, an injured persons’ advocacy group says.

Private company FairWay Resolution Services is contracted by the Accident Compensation Corporation to conduct the roughly 6000 reviews of ACC funding decisions conducted annually.

Lawyers who handle ACC cases have expressed concern that the contractual relationship between FairWay and the ACC — and the fact the ACC provides feedback to FairWay about review decisions — brought the independence of the review process into question.

Acclaim Otago spokeswoman Denise Powell said for many years there had been a strong idea the ACC and FairWay were ‘‘working hand in hand’’.

‘‘The issue as I see it is the perception people have around the independence of FairWay,’’ Dr Powell said.

‘‘Many feel that reviewers now have a vested interest in the outcomes of reviews, as if they ‘displease’ ACC by not meeting the KPIs [key performance indicators] of the contract, they potentially will no longer be engaged to provide reviews. This impacts their income.

‘‘It’s not rocket science to understand why people who are told this service is independent have questions around this in actuality.’’

An ACC spokesman said any suggestion reviewers were not independent of the ACC was a perception, not the reality.

‘‘The Accident Compensation Act requires reviewers to comply with the principles of natural justice.’’

One Dunedin man — who did not wish to be named as his case is before the court — is one ACC claimant who has lost faith in the review process.

A 2014 fall resulted in the man receiving cover for a neck sprain, but back trouble ensued and he received ACC funding for spinal surgery in 2015 and 2016.

However, excruciating pain resulted in the man returning to his surgeon, who applied in October last year for further ACC funding for another spinal operation.

The ACC obtained a specialist opinion that there was no connection between the man’s covered injuries and his need for surgery and rejected the application.

The man took the decision to review, but was again turned down.

‘‘I don’t see how they declined it,’’ he said,

‘‘I went down this road before years ago when they were using a different service and I got the decision overturned — that was more complicated but this one seemed more straightforward.

‘‘I just can’t see how they turned it down.’’

The man said he was looking for a lawyer to take the review to appeal.

Dr Powell said there were examples of reviewers having ‘‘friendly informal chats’’ ahead of time with ACC staff, while claimants were left in the waiting room.

‘‘In addition there are issues of course with the contract and the fact that ACC has ‘feedback’ sessions for those cases that are not decided in their favour.

‘‘It would be seen as inappropriate for individual lawyers or advocates to have similar ‘training’ or ‘feedback’ sessions for those cases that went against their clients. In fact most people would see that as inappropriate.’’

The ACC said a 2016 statutory review process confirmed, despite perception to contrary, reviewers did act independently of the ACC.