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CLAIMANT: Graeme Edwards did not know there was a claims code.
Insurance executive Graeme Edwards is a great fan of the ACC model, but his experience in making a claim after tearing a tendon from a bone, left him disillusioned.
It happened a year and a half ago, and Edwards, who works for giant international insurer AIA, was told by his surgeon he had a window of three and a half weeks to reattach it, or risk not getting back full use of his arm.
"If I'd been an All Black, I'd be operated on that afternoon," he said.
The surgeon marked his case "urgent" which means ACC moves quickly to assess his coverage.
But days passed, and there was no response.
Edwards called ACC, but he said the call centre operative wouldn't tell him the name of his case officer, or give their email. They would only pass on his messages.
He called again, and again, but the unnamed case officer didn't call back.
His surgeon warned him the "urgent" system was being overused for non-urgent cases which clogged up the system, So concerned he would miss his date on the table, he called AIA's claims manager.
Fortunately, he had a friend high up in ACC, and in an hour, his case officer called. Shortly afterwards, his surgery was approved.
Edwards said: "I am an educated, professional person with a decent income and connections. I thought about others who do not have those privileges."
Edwards never made a complaint. He didn't know there was a code of claimants rights. He was so relieved to get his surgery, he just got on with getting better.
He said a private insurer like AIA would never just fail to return calls to claimants.
When people make complaints, that sends a signal, Edwards believes, and if everyone demands change, it happens.
"They are answerable up the food chain to the Government, and they are answerable to the public," he said.
Since Edwards's experience, ACC has committed in its Statement of Intent 2014 to 2018, "to improve… customers' experience" and "lift the public's trust and confidence in ACC"
ACC PLANS TO LOWER COMPLAINTS
State insurance company, ACC, says it is becoming a more client-focused organisation, and aims to lower complaints.
It's an intention that indicates the no-faults accident compensation scheme, which is a form of national insurance against injury-caused lose of capacity and income, can be a difficult beast to deal with.
Every year thousands of ordinary people make claims to ACC.
But almost none of them are experts in ACC's laws, practices, and periodic attempts to bring down claims payments, depending on who is in Government.
Not being experts, people rely on ACC case officers to get it right, and to ensure they get the entitlements they have paid their levies for.
The number of times ACC case officers gets things wrong is unknown and unknowable, but errors happen, and fighting them can take years of gruelling court action for people whose capacity and financial resources have been reduced by injury.
And, just like dealing with a private insurer, it's up to individuals to do all they can to encourage ACC to do right by them.
Read the Code of ACC Claimants Rights
Created in 2003 after pressure from wronged claimants, it obligates ACC to meet the "highest practicable standards of service and fairness", and treat claimants with dignity, respect, honesty and courtesy.
Complain if your case manager is failing to live up to the code, which ACC insists it tells all claimants about.
Official figures show not many are complaining, but a report from the Auditor General last year concluded the ACC complaints system was complicated. Many claimants didn't know the process, and many complaints went unrecorded.
But there were bright points in the report, and ACC has said it is working to implement suggestions from the report.
Officially, in 2012 to 2013, ACC received just over 1600 complaints. The Auditor General thinks the real number that should have been recorded was probably closer to 20,700.
The 1600 figure is surprisingly few, considering over 9000 reviews of ACC decisions were taken.
The more people let minor abuses continue, or case officers treat them badly, the longer it will continue to happen.
Keep your own files
ACC is a monster when it comes to files.
It's not always managed to keep files well, and it can be hard to make it hand over files it has in its possession.
Until ACC operates internet-banking style online portals, where people get access to all their files, they should make sure to hang onto their own.
That means once every few months, asking for all records, emails, documents and notes held within the custody of the corporation that relate to their case.
The code says people have a right to be "fully informed", and that includes being able to read all the information kept about them.
Record conversations:
Michael Cruickshank has been fighting ACC for years, and has scored some notable victories including winning back-paid weekly compensation wrongfully denied him.
He now records all interactions with ACC, which is legal.
Cruickshank was once wrongly accused by an ACC staff member of making a threat to kill.
It was an allegation it took a long time to refute, but couldn't have happened had he been recording calls at the time.
Recordings also creates an evidence trail for a complaint.
It may seem like an aggressive thing to do, but businesses record conversations to protect their interests. Even making diary notes of each and every interaction creates such an evidence trail.
Tell your case officer you are making recordings. It's not a legal requirement, but it's courteous and puts them on warning.
Take every interaction seriously:
Every time you sign a form, or fill in information, or have a conversation, make sure to concentrate.
Read every word of the declarations you are being asked to make. The truth of ACC is that if your case officer gets something wrong, they get to apologise and move on, but if you even innocently make a false statement, you could find yourself dubbed a fraudster.
Your support person:
ACC must recognise a support person, so if you have a family member who is a lawyer, a business person, or an effective person, bring them in to help you.
This is especially important if you recognise you are the kind of person who finds it hard to stand your ground, or are likely to be making a very costly, or long-term claim.
Don't believe everything you are told:
Wheelchair-bound Marc McCloud was told by his case officer that he was only entitled to one ACC-paid taxi ride a week.
McCloud had documentation that showed otherwise. "I'll come down and show you," he told the case officer, who heard "I'll shoot you".
An armed offenders squad was waiting for him when he arrived.
Regardless of the misunderstanding, the ACC case officer was simply wrong in the tax advice.
They actually get much bigger things wrong too.
It took months for Police to drop charges against McCloud, who was represented by Wellington lawyer John Miller.
Miller holds a New Zealand record for the largest ever civil settlement.
It was $228 million for backdated payments to families of seriously injured claimants, to whom ACC had refused to pay full 24-hour care.
Unfortunately, the ability of ACC to get things wrong requires claimants to check up on everything they are told. Fortunately, ACC has a lot of good information on its website to help.
Never lose your head:
"If you lose your head, you lose control of your life," says Michael Cruickshank. Conflict is something that always goes against the claimant, Cruickshank claims. It can lead you to be quickly tagged as a troublemaker, and can quickly derail claims.
You have choices:
A top concern by claimants is that ACC sends them to medical professions sympathetic to ACC.
Some of the decisions medical assessors have made get overturned by the courts, and can be hard to comprehend. An example is the vocational independence assessment done in 2011 on Tolaga Bay resident Gary Hall who had injured his back in 2007.
The medical expert found Hall was vocationally independent, and so he came off ACC weekly compensation, and into the arms of the benefits system.
In October last year, the District Court in Wellington found no "reasonably informed employer could reach that conclusion".
ACC contracts these specialists and says it has processes to deal with performance problems. People can choose their own, as long as they have the necessary skills and qualifications, and are available within an appropriate timeframe.
In 2013, a Medical Assessment Project was established to lift public "trust and confidence in medical assessments", and included making claimants aware of their rights to choose.
- Sunday Star Times
http://ln.is/acclaimotago.org/NpRy4 … Please fill out survey on ACC #NZ to highlight to the UN failings of ACC to help people recover
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